Comparative study of total colectomy with subtotal colectomy for intractable slow transit constipation

Abstract

Objective To compare the clinical effect of total colectomy with subtotal colectomy for intractable slow transit constipation (STC). Methods From January 2014 to January 2016, seventy-eight cases of STC were diagnosed in the First People's Hospital of Huizhou City, and according to random number table method randomly divided into total resection group (39 cases underwent total colectomy and ileorectal anastomosis) and subtotal resection group (39 cases underwent subtotal colectomy and antiperistaltic cecoproctostomy). Data of patients were recorded with operation time, bleeding volume during operation, and postoperative hospitalization time in 2 weeks, antidiarrheals use ratio, complications and Wexner incontinence score, and patients were followed up for 12 months for Wexner constipation score, intractable diarrhea rate and patient satisfaction. Results There was no significant difference between the two groups in intraoperative bleeding volume, exhaust time and operative time. Postoperative hospitalization time and antidiarrheal use ratios of the total resection group was higher than the subtotal resection group, the difference was statistically significant (t=3.016, P=0.021; χ2=4.993, P=0.008). Postoperative Wexner constipation score decreased gradually after 12 months, and total resection group were significantly lower than subtotal group, the difference was statistically significant ( χ2=4.100, P=0.007). There was no significant difference for intractable diarrhea rate, while patients satisfaction and constipation recurrence is higher in total resection group than the subtotal resection group, the differences were statistically significant ( χ2=3.175, 4.905, 3.884, P=0.227, 0.027, 0.019). Conclusions Total resection of the colon and secondary resection of the colon have good effect in the treatment of intractable STC. The short term effect is better for the total resection of the colon, and the long term effect for subtotal resection. Key words: Constipation; Colectomy; Slow-transit