Laparoscopic-assisted surgery for constipation

Abstract

The aim of this study was to evaluate the safety, outcome and disability of various forms of laparoscopic-assisted colectomy for constipation. Between August 1991 and February 1995, 14 patients with constipation who underwent laparoscopic assisted total abdominal colectomy with ileorectal anastomosis (TAC + IR) or sigmoidectomy with colorectal anastomosis (SC + CR) with or without rectopexy were analyzed. Parameters included age, sex, preoperative medical treatment and evaluation, constipation score, indication for surgery, procedure performed, length of surgery, postoperative ileus, and hospitalization as well as morbidity, cosmesis, functional outcome and return to partial and full activity. Surgery was undertaken for colonic inertia (6 patients) and obstructing sigmoidocele with or without prolapse (8 patients) in 12 females and 2 males with a mean age of 47.5 (range 22–77) years. The mean history of laxative- or enema-dependent constipation was 18.3 (range 7–35) years and the mean constipation score was 24.4 (range 20–29). The overall mean operating time was 217.5 (range 125–325) min; 260 (range 195–315) min in the patients with TAC + IR, and 185.6 (range 125–325) min in the patients with SC + CR with or without rectopexy (P < 0.05). The mean length of postoperative ileus was 3.8 (range 2–7) days, and the length of hospitalization was 7.6 (range 4–15) days. There were 3 (21%) cases of intraoperative complications, and 4 cases of (29%) postoperative complications. At a mean follow-up of 37.8 (range 18–60) months, the mean frequency of bowel movements had increased from 2.5 per week preoperatively to 8.4 per week postoperatively (P < 0.0001). Ten patients reported excellent or good results relative to cosmesis. The mean time to return to partial activity was 1.7 (range 1–3) weeks, and return to full activity was 5.1 (range 3–10) weeks. Although laparoscopic procedures for constipation have definite advantages including better cosmesis and more rapid return to partial and full acitivity, disadvantages include the long operating time that may preclude its routine application.