Comparison of laparoscopic selective colectomy based on barium-strip examination and subtotal colectomy for adult slow-transit constipation

Zhao Hui Zhong; Shen Yang; Yong Zhao; Yuan Wang; Wei Dong Yong; Ling Ling Zhang; Qiu Sheng Wang; Xun Huang

doi:10.1093/gastro/goz020

Comparison of laparoscopic selective colectomy based on barium-strip examination and subtotal colectomy for adult slow-transit constipation

Gastroenterol Rep (Oxf). 2019 Jul 16;7(5):361-366. doi: 10.1093/gastro/goz020. eCollection 2019 Oct.

Authors

Zhao Hui Zhong¹, Shen Yang¹, Yong Zhao¹, Yuan Wang¹, Wei Dong Yong², Ling Ling Zhang², Qiu Sheng Wang¹, Xun Huang¹

Affiliations

¹ General Surgery Department, Peking University People's Hospital, Beijing, P.R. China.
² Insitute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.

Abstract

Background: Surgical management of adult slow-transit constipation (ASTC) can be effective for patients with intractable symptoms. This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.

Methods: A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014. Patients were evaluated by the barium-strip technique, colonoscopy, defecography and anorectal manometry. Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy (LSC) group underwent LSC at the precise location identified by barium strip. Spontaneous bowel movements, the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index (GIQLI) were assessed post-operatively at 3, 6, 12 and 24 months.

Results: A total of 49 patients were included in the analysis. The median follow-up was 37 months (range, 26-60 months). The mean post-operative hospital stay was 12 days and similar between groups (P = 0.071). The length of colon resection, operative time and intra-operative blood loss were reduced in the LSC group (all P < 0.05). No major complications occurred. A similar number of patients (24 in the standard group and 25 in the LSC group) exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer (P = 0.986). Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups, the mean GIQLI of the LSC group was significantly higher at 3, 6 and 24 months post-operatively (all P < 0.05).

Conclusions: LSC based on barium-strip examination is an appropriate modality for treating ASTC.

Keywords: barium strip; laparoscopic selective colectomy; laparoscopic subtotal colectomy; quality of life; slow-transit constipation.