A New Surgical Innovation for Chronic Constipation (Jinling Procedure): 2 Years Follow-up

Abstract

Purpose: Surgery is indicated for chronic constipation, which is refractory to conservative therapy. Of the three different types of constipation, the treatment of slow-transit constipation combined with outlet obstruction is controversial. This study proposed a surgical innovation, Jinling procedure, of which the safety, effectiveness and quality of life was examined over a 2-year follow up. Methods: Patients with refractory slow-transit constipation associated with outlet obstruction was strictly included. All received Jinling procedure, which added a new side-to-side anastomosis to colorectal posterior anastomosis after subtotal colectomy. Primary outcomes include safety (morbidity and adverse events), effectiveness (Wexner constipation score and satisfaction rate), and Gastrointestinal Quality of Life Index (GIQLI) documented at baseline and at 3, 6, 12 and 24 months. Results: Between Jan 2005 and Jun 2009, of the 304 patients, 214 (70.4%) received laparoscopic-assistant Jinling procedure; the other 90 (29.6%) received open Jinling procedure. 130 (42.8%) patients had previous surgical intervention without improvements. A total of 107 complications and adverse events were reported in 82 patients (morbidity rate of 35.3%). Most complications were managed conservatively. A significant reduction in Wexner constipation score was observed between baseline (mean 19.9) and 3 months (mean 8.3), which was maintained at 24 months (mean 4.4, p<0.001). Improvement in constipation score was matched by an overall improvement in GIQLI at 6-, 12- and 24-month follow-up.Table: No Caption available.Table 2: Safety data: morbidity and adverse eventsConclusion: Our clinical practice demonstrates that Jinling procedure is safe and effective for refractory slow-transit constipation associated with outlet obstruction, with minimal major complications, significant improvement of quality of life and high satisfaction rate after two-year follow up.Figure