[Choice of surgical procedures for refractory constipation].
Refractory constipations are mostly mixed constipations. Surgery is only reserved as the last option when conservative treatments have failed. Colectomy or stapbed transanal rectal resection (STARR) represents the procedure of choice in patients with pure slow transmit constipation (STC) or obstructive defecation syndrome (ODS). However, its clinical outcome is unsatisfactory. Jinling procedure, a new surgical innovation for mixed constipation, aims to correct the coexistence of STC and ODS in severe refractory constipation. It combines subtotal colectomy and side to side cecorectal anastomosis, which shows a promising clinical outcome in over 500 refractory constipation patients. In our department, there is no significant difference in operation time, mortality and complications between the laparoscopic assisted and open Jinling procedures. Jinling procedure is also appropriate for secondary Hirschsprung's disease. Stoma is described in the treatment of some adult constipation patients, which has not been supported by the evidence-based medicine at present. Anastomosis leakage is a severe complication after constipation surgery. Fecal diversion is indicated once it happened. Colon irrigation may be used in patients who failed after surgery or children who refused definitive operation. It has showed a good short-term functional recovery but becomes invalid after a long-term follow-up.
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Li
D000328:Adult; D003082:Colectomy; D003248:Constipation / Q000601:surgery*; D003672:Defecation; D006801:Humans; D010535:Laparoscopy; D016896:Treatment Outcome