Abstract
In October 2012, a 29-year-old woman affected by chronic constipation underwent surgery for a laparoscopic total colectomy with ileal j-pouch-rectal anastomosis. After a precise instrumental work-up, the patient was selected as a potential candidate for the surgical treatment after failing to respond to all other medical treatment. During the first three months following the surgery, the patient recorded 3 - 4 daily evacuations of soft stool. After the third month, the number of evacuations stabilised at 2 - 3 a day, with formed stool, and no mention of incontinence or abdominal pain. Although the laparoscopic total colectomy with ileorectal anastomosis (TC with IRA) and the laparoscopically assisted subtotal colectomy with cecorectal anastomosis (SC with CRA) are the most frequently practiced procedures in the surgical treatment of chronic constipation, the laparoscopic colectomy with ileal j-pouch has shown in our experience to be a feasible and effective procedure, with similar results to the two aforementioned procedures in terms of morbidity, mortality and quality of life. In fact, like the first two, the total colectomy with ileal j-pouch has demonstrated the advantages of laparoscopic surgery: low invasiveness, less post-operative pain or ileus, respect of parietal integrity, reduced hospitalization and, lastly, a better cosmesis.
Highlights
The numerous advantages, well-recognised, of laparoscopic surgery and laparoscopically assisted surgery have created the diffusion of laparoscopic colectomy surgery for the treatment of a benign pathology like chronic constipation refractory to pharmacologic therapy
We report a case of a 29-year-old woman treated with a laparoscopic total colectomy and ileal j-pouch to assess the advantages of this type of surgery in terms of morbidity, mortality and, above all, quality of life, in respect to two other patients who were treated with an ileorectal anastomosis without ileal pouch
Chronic slow transit constipation (STC) represents a syndrome characterised by constipation refractory to pharmacologic treatment, accompanied by chronic abdominal pain, nausea and flatulence, which above all affects young female patients [4,5]
Summary
The numerous advantages, well-recognised, of laparoscopic surgery and laparoscopically assisted surgery have created the diffusion of laparoscopic colectomy surgery for the treatment of a benign pathology like chronic constipation refractory to pharmacologic therapy. We report a case of a 29-year-old woman treated with a laparoscopic total colectomy and ileal j-pouch to assess the advantages of this type of surgery in terms of mor-. R.) came to our observation in April 2012 Among her symptoms was chronic constipation, with a single evacuation of solid stool every 8 - 10 days, chronic abdominal pain, nausea and flatulence. These symptoms persisted despite pharmacologic therapy based on oral fibers and fermented milks taken daily and a diet consisting of fruit, vegetables, pulses and two litres of water a day. The diagnostic process which the patient underwent in our De-
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