title: Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation.
abstract: BACKGROUND
  Subtotal colectomy with antiperistaltic cecorectal anastomosis (SCCRA) has proved to be an effective alternative to total colectomy for the treatment of severe slow-transit constipation. The laparoscopic approach has made this procedure even more attractive. This is the first controlled trial on laparoscopic SCCRA. The study compares the laparoscopic and the open approach.
  
  
  METHODS
  Since 2001, all SCCRAs have been performed laparoscopically at our institution. Only severely symptomatic patients are offered surgery, after stringent patient selection. Laparoscopic SCCRA was performed following the same steps that we first described for the open approach, by utilizing a five-trocar technique. Outcome parameters were prospectively collected every 3 and 6 months. Wexner constipation and incontinence scales (WCS, WI) and gastrointestinal quality of life index (GIQLI) were adopted for functional results. We conducted a case-control study of 15 consecutive patients who underwent laparoscopic SCCRA (VL) and 15 patients previously operated on by the open approach (Op) to compare postoperative and functional outcomes.
  
  
  RESULTS
  The VL group had better postoperative outcomes (pain, ileus) while complication rates were similar. Resolution of constipation was impressive in both groups, with no significant difference at follow-up. The VL group presented with a higher number of bowel movements at 3 months (3.8 vs. 2.8, p = 0.039), resulting in a significantly higher incontinence rate at 3 months (WI 6.4 vs. 2.73, p = 0.004), although the difference was no longer significant at 1-year follow-up. The quality of life was good for both groups; the VL group showed a significant improvement at 1-year follow-up (64.18 vs. 114.79, p < 0.01).
  
  
  CONCLUSIONS
  Laparoscopic SCCRA confirmed the good functional results of the open approach, with no increase in morbidity rate and a faster postoperative recovery. An early higher incontinence rate did not affect quality of life.
authors.affiliation: Section of General Surgical Clinics and Surgical Therapy, Department of Surgical Sciences, Parma University Medical School, Via Gramsci n.14, 43100 Parma, Italy. fede53@lycos.com
authors.forename: Federico
authors.initials: F
authors.lastname: Marchesi
authors.forename: Luigi
authors.initials: L
authors.lastname: Percalli
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Pinna
authors.forename: Stefano
authors.initials: S
authors.lastname: Cecchini
authors.forename: Matteo
authors.initials: M
authors.lastname: Ricco'
authors.forename: Luigi
authors.initials: L
authors.lastname: Roncoroni
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D002432:Cecum / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D003248:Constipation / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult