The long and short term outcome of laparoscopic subtotal colon resection combined manifold surgical methods for female with mixed constipation

Abstract

Objective To determine the clinical value of the subtotal colectomy combined with modified Duhamel procedure, anterior rectal suspension and uterine suspension surgery on outlet obstruction for patients with mixed constipation. Methods From February 2011 to February 2013, 15 female patients underwent laparoscopic procedure at our department. The clinical data and follow-up data were collected for 2 years postoperatively, including Hallbook bowel functional scale, Bristol stool scale, Wexner scale, gastrointestinal quality of life index, and patients’ satisfaction. Results The follow-up rate was 100%. The average age was 44.1±13.2 years, and the course of disease was 15.7±9.9 years. Fifteen patients were multipara,and slow transmit constipation was the main reason for constipation.Besides, one or more outlet obstructions were found in these patients. In this article, mild-to-moderate rectocele, rectal mucosal prolapse or fold, retroversion of uterus, descending perineum syndromes were found in 8/15 of patients synchronistically. All patients were followed at 1, 3, 6, 12 and 24 months postoperatively. The defecating frequency was 7.40±1.33/day, 5.43±1.28/day, 3.97±2.03/day, and 3.33±1.56/day respectively. It decreased steadily with significant differences (P 0.05). The time of evacuate bowel was less than 15 minutes postoperatively (P<0.05). Wexner scale score was significantly lower than that in pre-operation (P<0.001), and decreased gradually with time. The patientsʹ satisfaction, gastrointestinal quality of life index, Bristol stool scale, and Wexner score in the second year were 93.33%, 92.73±13.82, 4.60±0.91 and 7.67±3.21 respectively. Conclusions The subtotal colectomy combined with modified Duhamel procedure, anterior rectal suspension and uterine suspension surgery can improve the outlet obstruction for the mixed constipation. It has better short-term and long-term outcomes in self-control of anus, defecation function and satisfaction. Key words: Constipation; Surgical procedures, operative; Modified Duhamel procedure; Anterior rectal suspension; Uterine suspension