[Choice of surgical procedures for refractory constipation]

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Surgical Innovation

Background:

• Refractory constipation, often mixed, requires surgical intervention when conservative methods fail.
• Procedures like colectomy or STARR have limitations for mixed constipation.
• The Jinling procedure addresses coexisting slow transit constipation (STC) and obstructive defecation syndrome (ODS).

Discussion:

• The Jinling procedure combines subtotal colectomy with side-to-side cecorectal anastomosis for severe refractory constipation.
• Both laparoscopic-assisted and open Jinling procedures demonstrate comparable operative times, mortality, and complication rates.
• This technique is also applicable to secondary Hirschsprung's disease.

Key Insights:

• The Jinling procedure shows promising clinical outcomes in over 500 patients with severe refractory constipation.
• No significant differences were observed between laparoscopic and open Jinling procedures.
• Anastomotic leakage is a critical complication requiring fecal diversion.

Outlook:

• Further research may explore long-term efficacy and refine surgical techniques.
• Colon irrigation offers short-term benefits but lacks long-term effectiveness for refractory constipation.
• Evidence-based medicine is needed to support stoma use in adult constipation treatment.