The Role of Laparoscopic Total Colectomy in Treatment of Slow- Transit Constipation: A Prospective Study

Abstract

Background: Patients with intractable chronic constipation should be evaluated with physiologic tests after structural disorders, and extracolonic causes have been excluded. Conservative treatment options should be tried excessively. If surgery is indicated, subtotal or total colectomy with ileorectal anastomosis is the treatment method of choice. Patients and methods: In this prospective study, 7 patients were reviewed including patient demography, clinical manifestations, preoperative investigations, operative procedure, intraoperative and postoperative complications, and postoperative follow up. All patients enrolled in the study underwent laparoscopic total colectomy (LTC), with ileorectal anastomosis (IRA). Average age of the patients was (35±15.8 years), average operative time was (80±30 min), average blood loss was (75±30 ml), average hospital stay was (6±2.5 days). Results: 7 patients in our study were diagnosed to have slow-transit constipation via history, clinical examination, colonoscopy and barium enema to rule out structural disorders, colonic motility study, anorectal manometry, colonic transit time, and defecography. All patients underwent LTC with IRA after failure of conservative treatment. 3 patients(42.8%) had postoperative diarrhea which resolved spontaneously after 2 weeks, 1 patient (14.2%) had wound infection, 1patient(14.2%) had minor anastomotic leak which subsided on conservative treatment.2 patients had abdominal pain and bloating which improved gradually,1 patient had recurrent constipation which was improved on laxatives, median number of motions/day was 3, with median satisfaction and success rate of about 82%. Conclusion: Laparoscopic treatment of slow-transit constipation seems to be safe, feasible, and effective procedure with satisfactory results, with minimal postoperative complications, short hospital stay, with a faster return to social activity, along with a better cosmetic results and good functional results.