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Hand-assisted laparoscopic total colectomy for slow transit constipation.

Kevin C W Hsiao¹, Shu-Wen Jao, Chang-Chieh Wu

¹Division of Colon and Rectum Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China.

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|January 15, 2008

Summary

Hand-assisted laparoscopic total colectomy is a safe and effective surgical option for patients with slow transit constipation (STC) refractory to medical treatment. This minimally invasive approach demonstrates good patient satisfaction and low complication rates.

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Area of Science:

Gastroenterology
Minimally Invasive Surgery
Colorectal Surgery

Background:

Slow transit constipation (STC) presents a significant challenge, with medical treatments often proving ineffective.
Total colectomy with ileorectal anastomosis is a traditional surgical option for refractory STC.
Minimally invasive surgical techniques are increasingly adopted for colorectal procedures.

Purpose of the Study:

To evaluate the safety and efficacy of hand-assisted laparoscopic total colectomy for treating STC.
To assess the feasibility of this minimally invasive approach in patients with intractable constipation.

Main Methods:

A cohort of 44 women with medically refractory STC underwent hand-assisted laparoscopic total colectomy with ileorectal anastomosis.
Diagnostic workup included colonic transit tests, manometry, balloon expulsion, and barium enema.
Outcomes measured included operative time, blood loss, hospital stay, return of flatus, and complications.

Main Results:

The mean operative time was 197 minutes, with minimal blood loss (mean 113 ml).
No conversions to open surgery or surgical mortality were reported.
The mean hospital stay was 7.6 days, with 88.6% of patients reporting excellent or good satisfaction.

Conclusions:

Hand-assisted laparoscopic total colectomy is a safe and efficient surgical technique for STC.
This minimally invasive approach offers a viable treatment option for patients with severe, refractory constipation.