Subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy for the treatment of slow transit constipation in an aged population:A retrospective control study

AIM To compare the efficacy,improved quality of life,and prognosis in patients undergoing either subtotal colonic bypass with antiperistaltic cecoproctostomy(SCBAC) or subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy(SCBCAC) for the treatment of slow transit constipation.METHODS Between October 2010 and October 2014,aged patients with slow transit constipation who were hospitalized and underwent laparoscopic surgery in our institute weredivided into two groups: the bypass group,15 patients underwent SCBAC,and the bypass plus colostomy group,14 patients underwent SCBCAC. The following preoperative and postoperative clinical data were collected: gender,age,body mass index,operative time,first flatus time,length of hospital stay,bowel movements(BMs),Wexner fecal incontinence scale,Wexner constipation scale(WCS),gastrointestinal quality of life index(GIQLI),numerical rating scale for pain intensity(NRS),abdominal bloating score(ABS),and ClavienDindo classification of surgical complications(CD) before surgery and at 3,6,12,and 24 mo after surgery.RESULTS All patients successfully underwent laparoscopic surgery without open surgery conversion or surgeryrelated death. The operative time and blood loss were significantly less in the bypass group than in the bypass plus colostomy group(P = 0.007). No significant differences were observed in first flatus time,length of hospital stay,or complications with CD > 1 between the two groups. No patients had fecal incontinence after surgery. At 3,6,and 12 mo after surgery,the number of BMs was significantly less in the bypass plus colostomy group than in the bypass group. The parameters at 3,6,12,and 24 mo after surgery in both groups significantly improved compared with the preoperative conditions(P < 0.05),except NRS at 3,6 mo after surgery in both groups,ABS at 12,24 mo after surgery and NRS at 12,24 mo after surgery in the bypass group. WCS,GIQLI,NRS,and ABS significantly improved in the bypass plus colostomy group compared with the bypass group at 3,6,12,and 24 mo after surgery(P < 0.05) except WCS,NRS at 3,6 mo after surgery and ABS at 3 mo after surgery. At 1 year after surgery,a barium enema examination showed that the emptying time was significantly better in the bypass plus colostomy group than in the bypass group(P = 0.007).CONCLUSION Laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can significantly improve the prognosis. Its clinical efficacy is more favorable compared with that of SCBAC. Laparoscopic SCBCAC is a better procedure for the treatment of slow transit constipation in an aged population.

Subtotal colectomy with antiperistaltic cecoproctostomy is an alternative technique for two-stage management of obstructed left colon carcinoma

Left colon carcinoma presented with obstruction is a frequently encountered emergency. The surgical treatment of acutely obstructed left colon carcinoma （OLCC） still remains controversial because of its high associated morbidity and mortality, and the number of different surgical options available. Despite current trends toward emergency colectomy with primary anastomosis or colonic stenting as a bridge to subsequent elective surgery, the left hemicolectomy with temporary terminal colostomy remains a choice. Some of these patients who have received temporary colostomies are candidates for restoration of intestinal continuity when patient＇s medical conditions are optimized. The conventional open approach for the closure of left sided colostomies carries a significant morbidity with leakage rates ranging from 0 to 15% and an operative mortality reported as high as 10%. In fact, some patients with colostomies have significant intra-abdominal adhesions,which may result in difficulties in adequate mobilization of hepatic flexure and transverse colon and flawless anastomotic construction. Here we propose an alternative technique for the management of OLCC： subtotal colectomy with antiperistaltic cecoproctostomy.