title: [Novel surgery for refractory mixed constipation: analysis of the technical notes and outcome to Jinling procedure].
abstract: OBJECTIVE
  To discuss a new surgical strategy: Jinling procedure (subtotal colectomy combined with modified Duhamel procedure), of which the indications, technical notes and outcomes were analyzed.
  
  
  METHODS
  The 590 patients with refractory slow-transit constipation associated with outlet obstruction was strictly included between February 2000 and December 2011. The patients included 103 males and 487 females. Their age were 14-75 years (average 42 ± 13). The 412 patients received laparoscopic-assistant Jinling procedure, and 178 patients with open Jinling procedure. The pre- and post-operation data were collected. The follow up rate were 100%, 98.1%, 95.8% and 92.7% at 3, 6, 12 and 24 months.
  
  
  RESULTS
  There was no surgery-related death. Mean hospital day was (12 ± 9) days. Most complications were managed conservatively without significant events. The common complications after surgery were adhesive intestinal obstruction (9.2%), anastomosis bleeding (8.1%) and anastomosis leakage (2.9%). The gastrointestinal quality of life index score was 72 ± 9 preoperatively and increased to 68 ± 11, 99 ± 6, 105 ± 9, 106 ± 9 at 3, 6, 12 and 24 month follow-up, respectively (t = 62.1, -25.1, -126.5, -143.2, P < 0.01). The Wexner constipation scale was 21.9 ± 4.5 preoperatively and decreased to 9.6 ± 2.4, 5.9 ± 2.1, 4.6 ± 1.9, 4.5 ± 1.8 at 3, 6, 12 and 24 month follow-up, respectively (t = 48.6, 61.8, 58.2, 45.9, P < 0.01). The satisfactory rate was 77.5%, 92.1%, 93.0% and 94.1% at 3, 6, 12, and 24 month follow-up.
  
  
  CONCLUSIONS
  Jinling procedure provides a good surgical option for refractory slow-transit constipation associated with outlet obstruction.
authors.affiliation: Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Institute of People's Liberation Army for General Surgery, the Clinical College of the Nanjing University Medical School, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.forename: Wei-wei
authors.initials: WW
authors.lastname: Ding
authors.forename: Xiao-bo
authors.initials: XB
authors.lastname: Feng
authors.forename: Jian-lei
authors.initials: JL
authors.lastname: Liu
authors.forename: Xiong-hui
authors.initials: XH
authors.lastname: Hu
authors.forename: An-long
authors.initials: AL
authors.lastname: Yao
authors.forename: Wei-ming
authors.initials: WM
authors.lastname: Zhu
authors.forename: Jie-shou
authors.initials: JS
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003248:Constipation / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult