title: Comparison of hand-assisted laparoscopy with open total colectomy for slow transit constipation: a retrospective study.
abstract: OBJECTIVE
  To compare the efficacy and safety of hand-assisted laparoscopic colectomy (HALC) and open colectomy (OC) for patients with slow transit constipation (STC).
  
  
  METHODS
  Data of patients with STC who underwent total colectomy from January 2008 to December 2012 were retrospectively reviewed after clinical evaluation and an exclusion of secondary causes. These patients were further divided into the HALC and OC groups. Patients' outcomes, including intraoperative and postoperative data on their recovery and complications were compared between the two groups.
  
  
  RESULTS
  A total of 68 patients with STC were finally enrolled in the study, including 32 in the HALC group and 36 in the OC group. The baseline characteristics did not significantly differ between the two groups. Compared with the OC group, patients in the HALC group had a shorter length of incision, a longer operative time and less blood loss volume. There was no conversion to OC for patients undergoing HALC and no intraoperative complications in both groups. Furthermore, after operation, patients in HALC group experienced less pain (3.4 ± 0.7 vs 4.8 ± 1.0), earlier first passage of flatus (58.3 ± 6.3 h vs 73.4 ± 13.0 h), shorter length of postoperative hospital stay (8.8 ± 1.2 days vs 11.3 ± 1.7 days) but higher medical cost (RMB 33 979 ± 3 135 vs RMB 29 828 ± 3 216). The overall postoperative complications and the satisfaction in defecation were comparable in the two groups.
  
  
  CONCLUSIONS
  HALC is a safe, minimally invasive and effective surgical alternative for treating STC, which is comparable to OC.
authors.affiliation: Department of Colorectal and Anal Surgery, First Affiliated Hospital of the College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Qin Song
authors.initials: QS
authors.lastname: Sheng
authors.forename: Jian Jiang
authors.initials: JJ
authors.lastname: Lin
authors.forename: Wen Bin
authors.initials: WB
authors.lastname: Chen
authors.forename: Fan Long
authors.initials: FL
authors.lastname: Liu
authors.forename: Xiang Ming
authors.initials: XM
authors.lastname: Xu
authors.forename: Han Ju
authors.initials: HJ
authors.lastname: Hua
authors.forename: Cai Zhao
authors.initials: CZ
authors.lastname: Lin
authors.forename: Jin Hai
authors.initials: JH
authors.lastname: Wang
mesh_terms: D000328:Adult; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003248:Constipation / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005772:Gastrointestinal Transit; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: colectomy; colonic transit time; constipation; hand-assisted laparoscopic colectomy; slow transit constipation