Hand-assisted laparoscopic total colectomy for slow transit constipation.
OBJECTIVE
Current medical treatments for slow transit constipation (STC) are often ineffective, and total colectomy with ileorectal anastomosis has been the procedure of choice for selected patients with refractory STC. Today, minimally invasive approaches are being utilized in a greater number of procedures as surgeons become more familiar with the techniques involved. The aim of this study was to assess the safety and utility of hand-assisted laparoscopic total colectomy for STC.


METHODS
From January 2002 to December 2005, 44 women presented with complaints of intractable constipation and failed to respond to medical treatment. Slow transit constipation was diagnosed after a series of examinations, including a colonic transit test, anal manometry, balloon expulsion test, and barium enema. All eligible patients underwent a hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Main outcome measures included the operative time, conversion to open procedure, blood loss, time to return of flatus, length of postoperative hospital stay, and complications.


RESULTS
The mean operative time was 197 min (range, 125-295 min). The mean estimated blood loss was 113 ml (range, 100-300 ml). The mean day of first time to flatus was 2 days, and the mean hospital stay was 7.6 days. There was no conversion to an open procedure and no surgical mortality. In the following period, two patients developed intestinal obstruction, which underwent exploratory laparotomy. However, some 39 patients (88.6%) expressed excellent or good in satisfaction.


CONCLUSIONS
Hand-assisted laparoscopic total colectomy could be a safe and efficient technique in the treatment of STC.
Hsiao
Kevin C W
KC
Division of Colon and Rectum Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China.
Jao
Shu-Wen
SW
Wu
Chang-Chieh
CC
Lee
Tsai-Yu
TY
Lai
Huang-Jen
HJ
Kang
Jung-Cheng
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003248:Constipation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011312:Pressure; D011860:Radiography, Abdominal / Q000379:methods; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome