Efficacy and Safety of Laparoscopy-Assisted Subtotal Colectomy Combined Modified Duhamel Procedure for Severe Functional Constipation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SUN Wei , CHEN Aishan , YAN Zhaopeng , CAO Xiankui , YIN Hongzhuan , YIN Jianqiao , SU Qi ,  LIU Baolin

Department of Colon Rectal Anal Surgery， Shengjing Hospital， China Medical University， Shenyang 110004， Liaoning Province， China;

Corresponding author：

LIU Baolin, Email: liubl@sj-hospital.org

Keywords：

Modified Duhamel surgery; Severe functional constipation; Gastrointestinal living quality score; Defecation improvement degree

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Objective 　To summarize the short-term efficacy， surgery complications， and relative experiences in the management of severe functional constipation （SFC） under laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure.
Methods 　All the data of 15 patients underwent laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure from March 2010 to August 2011 were collected retrospectively， all the patients were diagnosed as SFC and failed to conservative therapy. The postoperative short-term efficacy， complications of surgery， score of gastrointestinal living condition， and improvement degree of defecation were analyzed.
Results 　All 15 procedures achieved success， the operation time was （247.33±55.10） min， the intraoperative blood loss volume was （107.33±45.59） ml， the incision length was （8.40±2.41） cm， the postoperative out of bed activity time was （2.27±1.28） d，the postoperative passage of gas by anus time was （2.60±1.89） d， the postoperative defecation time was （2.87±2.50） d，the postoperative foods taken per oral time was （3.07±1.16） d， the hospital stay was （12.64±2.37） d. Approximately on day 3-4 after operation， 10 patients presented with postoperative diarrhea but were all under control with antidiarrheals efficiently. One patient presented with incomplete bowel obstruction on day 8 after operation and one patient with stomal leakage complicated with deep infection on day 9 after operation， who both recovered under conservative therapy. The scoreof gastrointestinal living quality on month 1 after operation was significantly higher than that on day 1 before operation （121.80±4.72 versus 90.80±7.24， P=0.000）， and the improvement degree of defecation was （0.81±0.56）%.
Conclusions 　From the limited case informations， the laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure has a certain short-term curative effect in treatment for SFC with the advantages of faster recovery， less bleeding， shorter hospital stay， and fewer complications.

Citation： SUN Wei,CHEN Aishan,YAN Zhaopeng,CAO Xiankui,YIN Hongzhuan,YIN Jianqiao,SU Qi,LIU Baolin,.. Efficacy and Safety of Laparoscopy-Assisted Subtotal Colectomy Combined Modified Duhamel Procedure for Severe Functional Constipation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(2): 169-173. doi: Copy

1.	郭晓峰，柯美云，潘国宗，等. 北京地区成人慢性便秘整群、分层、随机流行病学调查及其相关因素分析[J]. 中华消化杂志， 2002， 22(10)：637-638.
2.	于普林，李增金，郑宏，等. 老年人便秘流行病学特点的初步分析[J]. 中华老年医学杂志， 2001， 20(2)：132-134.
3.	姜军，李宁，朱维铭，等. 手助腹腔镜结肠次全切除联合改良Duhamel术治疗重度功能性便秘[J]. 医学研究生学报， 2007， 20(9)：931-933， 937.
4.	Peppas G， Alexiou VG， Mourtzoukou E， et al. Epidemiology of constipation in Europe and Oceania：a systematic review[J]. BMC Gastroenterol， 2008， 8：5.
5.	Błachut K， Bednarz W， Paradowski L. Surgical treatment of cons-tipation[J]. Rocz Akad Med Bialymst， 2004， 49：47-52.
6.	孟荣贵，郝立强，傅传刚，等. 结肠慢传输型便秘的诊断和治疗[J]. 中国实用外科杂志， 2002， 22(12)：719-721.
7.	Lundin E， Karlbom U， Westlin JE， et al. Scintigraphic assessment of slow transit constipation with special reference to right-or left-sided colonic delay[J]. Colorectal Dis， 2004， 6(6)：499-505.
8.	Scarpa M， Barollo M， Keighley MR. Ileostomy for constipation：long-term postoperative outcome[J]. Colorectal Dis， 2005， 7(3)：224-227.
9.	李红岩，张燕，赵发. 改良结肠旷置术治疗老年顽固性便秘[J]. 中华胃肠外科杂志， 2010， 13(7)：543.
10.	Longstreth GF， Thompson W G， Chey W D， et al. Functional boweldisorders[J]. Gastroenterology， 2006， 130(5)：1480-1491.
11.	陶琦，钱群，江从庆，等. 胃肠道生存质量指数在慢传输型便秘患者手术疗效评估中的应用[J]. 中华胃肠外科杂志， 2008， 11(5)：509-511.
12.	Eypasch E， Williams JI， Wood-Dauphinee S， et a1. Gastrointestinal quality of life index：development， validation and applicationof a new instrument[J]. Br J Surg， 1995， 82：216-222.
13.	中华医学会外科学分会肛肠外科学组. 便秘症状及疗效评估[J]. 中华胃肠外科杂志， 2005， 8(4)：355.
14.	Bassotti G， Villanacci V， Maurer CA， et al. The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation[J]. Gut， 2006， 55(1)：41-46.
15.	Tomita R， Fujisaki S， Ikeda T， et al. Role of nitric oxide in the colon of patients with slow-transit constipation[J]. Dis Colon Rectum， 2002， 45(5)：593-600.
16.	Mitolo-Chieppa D， Mansi G， Rinaldi R， et al. Cholinergic stimulation and nonadrenergic， noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation[J]. DigDis Sci， 1998， 43(12)：2719-2726.
17.	Costagliola A， Russo D， Izzo AA， et al. Distribution and activityof fatty acid amide hydralase (FAAH) in the gastrointestinal neuronsof mouse[J]. Anat Histol Embryol， 2005， 34(s1)：13.
18.	Lee JI， Park H， Kamm MA， et al. Decreased density of interstitial cells of Cajal and neuronal cells in patients with slow-transit constipation and acquired megacolon[J]. J Gastroenterol Hepatol， 2005， 20(8)：1292-1298.
19.	Madrid AM， Defilippi C. Disturbances of small intestinal motility in patients with chronic constipation[J]. Rev Med Chil， 2006， 134(2)：181-186.
20.	Wang KS， Ma T， Filiz F， et al. Colon water transport in transgenic mice lacking aquaporin-4 water channels[J]. Am J PhysiolGastrointest Liver Physiol， 2000， 279(2)：G463-G470.
21.	Rotholtz NA， Steven DW. Surgical treatment of constipation and fecal incontinence[J]. Gastroenterol Clin North Am， 2001， 30(1)：131-166.
22.	Tong WD， Liu BH， Zhang SB， et al. Abdominal colectomy as a treatment of obstinate slow transit constipation：clinical results and aetiological analysis[J]. Formos J Surg， 2003， 36：112-119.
23.	Jiang CQ， Qian Q， Liu ZS， et al. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation－from Chinese report[J]. Int J Colorectal Dis， 2008， 23(12)：1251-1256.
24.	Conzo G， Stanzione F， Celsi S， et al. Videolaparo-assisted subt-otal colectomy with cecorectal anastomosis in the treatment of chro-nic slow transit constipation[J]. G Chir， 2011， 31(11-12)：487-490.
25.	刘宝华. 顽固性便秘的外科治疗[J]. 中国实用外科杂志， 2007， 27(6)：492-494.
26.	Fitzharris GP， Garcia-Aguilar J， Parker SC， et al. Quality of life after subtotal colectomy for slow-transit constipation：both quality and quantity count[J]. Dis Colon Rectum， 2003， 46(4)：433-440.
27.	Iannelli A， Fabiani P， Mouiel J， et al. Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation[J]. Surg Endosc， 2006， 20(1)：171-173.
28.	Aldulaymi BH， Rasmussen OØ， Christiansen J. Long-term resultsof subtotal colectomy for severe slow-transit constipation in patientswith normal rectal function[J]. Colorectal Dis， 2001， 3(6)：392-395.
29.	El-Tawil AM. Reasons for creation of permanent ileostomy for the management of idiopathic chronic constipation[J]. J Gastroenterol Hepatol， 2004， 19(8)：844-846.

1. 郭晓峰，柯美云，潘国宗，等. 北京地区成人慢性便秘整群、分层、随机流行病学调查及其相关因素分析[J]. 中华消化杂志， 2002， 22(10)：637-638.
2. 于普林，李增金，郑宏，等. 老年人便秘流行病学特点的初步分析[J]. 中华老年医学杂志， 2001， 20(2)：132-134.
3. 姜军，李宁，朱维铭，等. 手助腹腔镜结肠次全切除联合改良Duhamel术治疗重度功能性便秘[J]. 医学研究生学报， 2007， 20(9)：931-933， 937.
4. Peppas G， Alexiou VG， Mourtzoukou E， et al. Epidemiology of constipation in Europe and Oceania：a systematic review[J]. BMC Gastroenterol， 2008， 8：5.
5. Błachut K， Bednarz W， Paradowski L. Surgical treatment of cons-tipation[J]. Rocz Akad Med Bialymst， 2004， 49：47-52.
6. 孟荣贵，郝立强，傅传刚，等. 结肠慢传输型便秘的诊断和治疗[J]. 中国实用外科杂志， 2002， 22(12)：719-721.
7. Lundin E， Karlbom U， Westlin JE， et al. Scintigraphic assessment of slow transit constipation with special reference to right-or left-sided colonic delay[J]. Colorectal Dis， 2004， 6(6)：499-505.
8. Scarpa M， Barollo M， Keighley MR. Ileostomy for constipation：long-term postoperative outcome[J]. Colorectal Dis， 2005， 7(3)：224-227.
9. 李红岩，张燕，赵发. 改良结肠旷置术治疗老年顽固性便秘[J]. 中华胃肠外科杂志， 2010， 13(7)：543.
10. Longstreth GF， Thompson W G， Chey W D， et al. Functional boweldisorders[J]. Gastroenterology， 2006， 130(5)：1480-1491.
11. 陶琦，钱群，江从庆，等. 胃肠道生存质量指数在慢传输型便秘患者手术疗效评估中的应用[J]. 中华胃肠外科杂志， 2008， 11(5)：509-511.
12. Eypasch E， Williams JI， Wood-Dauphinee S， et a1. Gastrointestinal quality of life index：development， validation and applicationof a new instrument[J]. Br J Surg， 1995， 82：216-222.
13. 中华医学会外科学分会肛肠外科学组. 便秘症状及疗效评估[J]. 中华胃肠外科杂志， 2005， 8(4)：355.
14. Bassotti G， Villanacci V， Maurer CA， et al. The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation[J]. Gut， 2006， 55(1)：41-46.
15. Tomita R， Fujisaki S， Ikeda T， et al. Role of nitric oxide in the colon of patients with slow-transit constipation[J]. Dis Colon Rectum， 2002， 45(5)：593-600.
16. Mitolo-Chieppa D， Mansi G， Rinaldi R， et al. Cholinergic stimulation and nonadrenergic， noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation[J]. DigDis Sci， 1998， 43(12)：2719-2726.
17. Costagliola A， Russo D， Izzo AA， et al. Distribution and activityof fatty acid amide hydralase (FAAH) in the gastrointestinal neuronsof mouse[J]. Anat Histol Embryol， 2005， 34(s1)：13.
18. Lee JI， Park H， Kamm MA， et al. Decreased density of interstitial cells of Cajal and neuronal cells in patients with slow-transit constipation and acquired megacolon[J]. J Gastroenterol Hepatol， 2005， 20(8)：1292-1298.
19. Madrid AM， Defilippi C. Disturbances of small intestinal motility in patients with chronic constipation[J]. Rev Med Chil， 2006， 134(2)：181-186.
20. Wang KS， Ma T， Filiz F， et al. Colon water transport in transgenic mice lacking aquaporin-4 water channels[J]. Am J PhysiolGastrointest Liver Physiol， 2000， 279(2)：G463-G470.
21. Rotholtz NA， Steven DW. Surgical treatment of constipation and fecal incontinence[J]. Gastroenterol Clin North Am， 2001， 30(1)：131-166.
22. Tong WD， Liu BH， Zhang SB， et al. Abdominal colectomy as a treatment of obstinate slow transit constipation：clinical results and aetiological analysis[J]. Formos J Surg， 2003， 36：112-119.
23. Jiang CQ， Qian Q， Liu ZS， et al. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation－from Chinese report[J]. Int J Colorectal Dis， 2008， 23(12)：1251-1256.
24. Conzo G， Stanzione F， Celsi S， et al. Videolaparo-assisted subt-otal colectomy with cecorectal anastomosis in the treatment of chro-nic slow transit constipation[J]. G Chir， 2011， 31(11-12)：487-490.
25. 刘宝华. 顽固性便秘的外科治疗[J]. 中国实用外科杂志， 2007， 27(6)：492-494.
26. Fitzharris GP， Garcia-Aguilar J， Parker SC， et al. Quality of life after subtotal colectomy for slow-transit constipation：both quality and quantity count[J]. Dis Colon Rectum， 2003， 46(4)：433-440.
27. Iannelli A， Fabiani P， Mouiel J， et al. Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation[J]. Surg Endosc， 2006， 20(1)：171-173.
28. Aldulaymi BH， Rasmussen OØ， Christiansen J. Long-term resultsof subtotal colectomy for severe slow-transit constipation in patientswith normal rectal function[J]. Colorectal Dis， 2001， 3(6)：392-395.
29. El-Tawil AM. Reasons for creation of permanent ileostomy for the management of idiopathic chronic constipation[J]. J Gastroenterol Hepatol， 2004， 19(8)：844-846.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy and Safety of Laparoscopy-Assisted Subtotal Colectomy Combined Modified Duhamel Procedure for Severe Functional Constipation

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