title: Novel surgery for refractory mixed constipation: Jinling procedure - technical notes and early outcome.
abstract: BACKGROUND
  The treatment of slow-transit constipation combined with outlet obstruction is controversial. This study introduced a new surgical strategy, subtotal colectomy combined with a modified Duhamel procedure (Jinling procedure), of which the safety and satisfactory rate were examined.
  
  
  METHODS
  Ninety patients with refractory slow-transit constipation associated with outlet obstruction were consecutively included between Jan 2010 and Dec 2010. All underwent the laparoscopic-assisted Jinling procedure, which added a new side-to-side anastomosis to the colorectal posterior anastomosis after subtotal colectomy. The pre- and post-operative data were collected.
  
  
  RESULTS
  There was no surgery-related death. A total of 39 complications and adverse events were reported in 22 patients (morbidity rate of 24.4%). Most complications were managed conservatively without significant events. The satisfactory rate was 93.1% at 6-month follow-up.
  
  
  CONCLUSIONS
  The Jinling procedure is safe for refractory slow-transit constipation associated with outlet obstruction, with minimal major complications and a high satisfaction rate. However, this procedure requires rigorous preoperative examination, exquisite surgical and laparoscopic techniques and excellent perioperative management. The pelvic floor, especially the presacral space, is damaged, and therefore it may be unsalvageable if severe complications, such as anastomosis leakage or ischemia, occur.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Ding
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Feng
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Anlong
authors.initials: A
authors.lastname: Yao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
keywords: constipation; safety; surgery