Influence Of Rectal Retention Length On The Effect Of Laparoscopic Total Colectomy With Ileorectal Anastomosis In The Treatment Of Slow Transit Constipation

BackgroundChronic constipationseriously affect the life quality of patients,the Slow Transit Constipation(STC)conservative treatment invalid need surgical treatment.Total colectomy and ileorectal anastomosis(IRA)was the most effective to improve constipation,widely used at home and abroad.However,the disadvantages of this method are more complications,and there is no uniform standard in the literature about the length of rectal retention.Laparoscopic total colectomy and ileorectal anastomosis for the treatment of slow transit constipation(STC)is a safe,effective and minimally invasive,quick recovery operation.Therefore,to improve the operation of total colectomy and ileorectal anastomosis,it can better improve the postoperative curative effect,reduce postoperative complications and improve the quality of life of patients.ObjectiveTo observe the short-term clinical effect of laparoscopic colon resection ileorectal anastomosis in the treatment of slow transit constipation,to investigate the effect of different rectal retention lengths of laparoscopic total colectomy with ileorectal anastomosis in the treatment of slow transit constipation,In order to guide the rational choice of surgical methods for clinical surgeons,develop optimal treatment options.Methods45 STC patients treated by laparoscopic total colectomy with ileorectal anastomosis between Sep 2008 and June 2014 at our institution were divided into observation group and control group.The observation group(21 cases)from the peritoneal reflection above 10-12 cm transect rectum for ileorectal anastomosis;The control group(24 cases)from the peritoneal reflection above 2-3 cm transect rectum for ileorectal anastomosis.All patients were treated by outpatient visits,telephone follow-up and questionnaire survey for at least two years of follow-up,The basic information(gender,age,Body Mass Index BMI),perioperative data(operation time,blood loss,the first exhaust time,hospitalization time and complications)and clinical data(Wexner constipation score(WCS),gastrointestinal quality of life index(GIQLI),Wexner incontinence score(WIS),abdominal pain,abdominal distension,the number of stools per day(BM))of the two groups were collected and compared before and 3,6,24 months after operation.To observe the effect on post clinical efficacy of different rectal retention lengths in the treatment of slow transit constipation ResultsTwo groups of patients were successfully performed laparoscopic surgery,no conversion to open surgery and death cases,Two groups of patients with basic information(gender,age,Body Mass Index BMI),perioperative data(operation time,blood loss,the first exhaust time,hospitalization time and complications),clinical data(Wexner constipation score(WCS),gastrointestinal quality of life index(GIQLI),Wexner incontinence score(WIS),abdominal pain,abdominal distension,the number of stools per day(BM))berore operation was no obvious difference(P>0.05);months after the operation Wexner constipation score(WCS),gastrointestinal quality of life index(GIQLI),abdominal pain frequency score and abdominal distension frequency score were compared with the preoperative significantly improved and was statistically significant(P < 0.05),The WCS,GIQLI,abdominal pain frequency scores and abdominal distension frequency score at each time point after operation compared were not statistically significant(P > 0.05);At 3,6months after operation abdominal distension frequency score of observation group were better than that of control group(P<0.05),At 24 months compared was not statistically significant(P>0.05);At 3,6,24 months after the operation between two groups,the number of stools per day(BM)、 Wexner incontinence score(WIS)and rectal maximum tolerance capacity of observation group were better than control group and there was statistical significance(P<0.05).ConclusionThe effect of Laparoscopic total colectomy with ileorectal anastomosis in the treatment of slow transit constipation was significant,increasing rectal retention length can improve patient’s recent life quality.