title: Long-term follow-up of the Jinling procedure for combined slow-transit constipation and obstructive defecation.
abstract: BACKGROUND
  Surgery is indicated for chronic constipation refractory to conservative therapy. The treatment of combined slow-transit constipation and obstructive defecation is controversial.
  
  
  OBJECTIVE
  The aim of the study is to describe the Jinling procedure and examine safety, effectiveness, and quality of life over 4 years of follow-up.
  
  
  METHODS
  The study is a retrospective review of prospectively gathered data in a patient registry database.
  
  
  METHODS
  This investigation was conducted at a tertiary-care gastroenterology surgical center in China.
  
  
  METHODS
  The study included 117 consecutive patients with slow-transit constipation combined with obstructive defecation treated between January 2005 and December 2007.
  
  
  METHODS
  The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis to solve the coexistence of obstructive defecation and slow-transit constipation in one operation.
  
  
  METHODS
  We measured morbidity and mortality rates, Wexner constipation scores, and Gastrointestinal Quality of Life Index at baseline and after 1, 6, 12, 24, 36 and 48 months of follow-up.
  
  
  RESULTS
  A total of 117 patients underwent the Jinling procedure, which was laparoscopically assisted in 56 patients (47.9%) and an open procedure in 61 patients (52.1%). Of the total, 72 patients (61.5%) had undergone previous surgical intervention without improvement. A total of 28 complications and adverse events were reported in 117 procedures, giving an overall morbidity rate of 23.9%; 23 patients (19.7%) had 1 or more events. Most complications were managed conservatively. A significant reduction in Wexner constipation score was observed from baseline (mean, 21.9) to 1 month (mean, 9.8), and the reduction was maintained at 48 months (mean 5.1; p < 0.001). Compared with baseline, significant overall improvements were also seen in gastrointestinal quality of life at 12, 24, and 48 months of follow-up (p < 0.01).
  
  
  CONCLUSIONS
  This study did not include a comparison group.
  
  
  CONCLUSIONS
  Our clinical practice demonstrates that Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after 4-year follow up.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, People's Republic of China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Feng
authors.forename: Weiwei
authors.initials: W
authors.lastname: Ding
authors.forename: Jianlei
authors.initials: J
authors.lastname: Liu
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002681:China / Q000453:epidemiology; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003106:Colon / Q000503:physiopathology / Q000601:surgery; D003248:Constipation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D003672:Defecation / Q000187:drug effects; D004351:Drug Resistance; D005244:Fecal Impaction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008365:Manometry / Q000379:methods; D057240:Patient Preference; D011788:Quality of Life; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome