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Single-incision clipless laparoscopic total colectomy for intractable slow transit constipation: a single surgeon's

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Single-incision clipless laparoscopic total colectomy with ileorectal anastomosis is a feasible and safe option for severe slow transit constipation. The functional end-to-end anastomosis technique is preferred for patients with rectal fecal loading.

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Gastroenterology

Background:

  • Intractable slow transit constipation (STC) poses significant challenges in patient management.
  • Surgical interventions are considered for refractory STC cases.
  • Single-incision clipless laparoscopic total colectomy with ileorectal anastomosis (SCLTC with IRA) has been utilized since 2011.

Purpose of the Study:

  • To evaluate the feasibility and clinical usefulness of SCLTC with IRA for patients suffering from intractable STC.
  • To compare outcomes between two different anastomosis techniques within SCLTC with IRA.

Main Methods:

  • A retrospective study of 22 patients with intractable STC who underwent SCLTC with IRA between January 2011 and December 2018.
  • Patients were divided into two groups: double stapling technique (DST) with IRA (n=12) and functional end-to-end anastomosis (FEEA) with IRA (n=10).
  • Surgical time, postoperative outcomes, and long-term complications were analyzed.

Main Results:

  • Surgical time was significantly shorter in the FEEA group (median 185 min) compared to the DST group (median 230 min) (P=0.035).
  • No significant differences were observed in patient demographics, intraoperative blood loss, postoperative hospital stay, or daily stool frequency at 1 month post-surgery.
  • No major complications like anastomotic leakage or bowel obstruction occurred in either group up to 3 years post-surgery.

Conclusions:

  • SCLTC with IRA is a feasible and safe surgical approach for managing intractable STC.
  • The FEEA technique is particularly advantageous over DST in SCLTC with IRA for patients with residual rectal contents.
  • This study supports SCLTC with IRA as an effective treatment for severe constipation.