title: Laparoscopic treatment of chronic slow transit constipation. Report of three cases and review of literature.
abstract: BACKGROUND
  The Authors present their experience with laparoscopic total or subtotal colectomy (TC or SC) in three patients operated for intractable chronic slow transit constipation (STC), together with a review of literature.
  
  
  METHODS
  From July 2005 to July 2009 three young patients affected by STC, after meticulous preoperative instrumental work-up and after failure of medical treatment, were submitted to laparoscopic TC and ideo rectal anastomosis (IRA) in two cases and to laparo assisted SC followed by Ceco Rectal Anastomosis (CRA) in one case. Number of daily bowel motions, urgency soiling, incontinence, abdominal pain, bloating with special regard to patient's quality of life, were analyzed.
  
  
  RESULTS
  All the interventions were completed via laparoscopic approach. No postoperative morbidity or mortality were observed. After twelve months, the patients referred two-three daily evacuation of soft stool, with a good continence and disappearance of abdominal pain and other relatives symptoms. They reported excellent satisfaction with the surgical results and a significant improvement of their quality of life.
  
  
  CONCLUSIONS
  TC with IRA and CRA after SC represent the most effective and widely used surgical operations in the treatment of STC, in well selected patients, after failure of conservative treatment. According to Literature data, and in our experience, no significant differences in terms of postoperative morbidity or mortality neither in quality of life were observed between the two operations. It is well demonstrated the feasibility of the laparoscopic approach in treatment of colorectal pathologies with typically advantages of less invasive surgery, respect of parietal integrity, less postoperative pain and ileus, fewer postoperative adhesions, a reduced hospitalisation and finally a better cosmesis.
  
  
  CONCLUSIONS
  Laparoscopic TC and IRA and CRA after laparo assisted SC represent efficacious operations in the treatment of STC offering a good postoperative quality of life and reduced morbidity compared to open surgery.
authors.affiliation: Seconda Universitrà degli Studi di Napoli, Facoltà di Medicina e Chirurgia, Napoli Dipartimento di Scienze Anestesiologiche, Chirurgiche e dell'Emergenza, VII Divisione di Chirurgia Generale. giovanni.conzo@unina2.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Alfredo
authors.initials: A
authors.lastname: Allaria
authors.forename: Francesco
authors.initials: F
authors.lastname: Stanzione
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Candela
authors.forename: Claudio
authors.initials: C
authors.lastname: Mauriello
authors.forename: Landino
authors.initials: L
authors.lastname: Fei
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003248:Constipation / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D010535:Laparoscopy; D055815:Young Adult