Laparoscopic Sub-total Colectomy with Anti-peristaltic ileosigmoid anastomosis(ZHU’s operation) for the treatment of slow-transit constipation?therapeutic evaluation(36 cases report)

Anlong Zhu. the First Affiliated Hospital of Harbin Medical University

Objective :To assess the operative outcomes after laparoscopic subtotal colectomy with antiperistaltic ileosigmoid anastomosis (ZHU’s operation or LSCAISA)for the slow-transit constipation.

Methods:reviewed January 2009 and May 2014 the patients with slow-transit constipation underwent laparoscopic subtotal colectomy with antiperistaltic.The following pre-operative information were collected: the number of pre-operative bowel movements, constipation intervals, the frequency of using laxative, the variation rang of weight .The following postoperative information were collected: the number of postoperative bowel movements,peri-operative complications (incision infection,pneumonia,fistula of intestine,perilymph fistula ), forwards complications(malnutrition, bellyache, intestinal obstruction ),Wexner score and degree of postoperative satisfaction.

Results : 36 patients were counted. Half month after the operation,bowel frequency was a mean of 7±2 daily,with a semi—liquid stool consistency.Three months after the operation,bowel frequency was a mean of 4±2 daily, with a semi-solid stool consistency.Six months after the operation,bowel frequency was a mean of 3±1 daily,with a a solid stool consistency mostly.One year after the operation,bowel frequency was a mean of 2±1 daily,with a solid stool consistency mostly.One patient’s bowel frequency was a mean of 10 daily after six months?One elderly female patient get pneumonia in the peri-operative period and two fat patients present incision infection.Four patients occur postoperative paroxysmal bellyache.Two patients got ileus and two patients got Perilymph fistula .There were no short-term or long-term complications in the other patients.69.4% patients reported a great satisfaction, 13.9% patients expressed satisfaction and 16.7% showed basically satisfaction. The mean preoperative Wexner’s score was 20.5±3.7, which decreased to an average post-operative score of 4.8±2.3 a year later.

Conclusions: laparoscope sub-total colectomy with anti-peristaltic ileosigmoid anastomosis for the slow-transit constipation seemed to be a safe and effective procedure for selected patients. However, long-term symptomatic and functional outcome need further study.

Table 1.Clinical characteristics

Age(yr) 46(18-73)

Gender

Male/female 6/30

operation

Subtotal Colectomy with Anti-peristaltic ileosigmoid anastomosis 36

Unite STARR 2

Operation time (min) 140±20

Hospital stay (day) 9±1

bleeding volume (ml) 70±30

length of abdominal incision( cm) 5±0.5

follow-up duration(mo) 14

Table 2 Postoperative complication and management

Complication Management No.(%)

Early (≤1 mo) 8(27.8)

Postoperative ileus operation 1(2.7)

Wound infection conservative 2(5.6)

Perilymph fistula conservative 2(5.6)

pneumonia conservative 1(2.7)

paroxysmal bellyache conservative 4(11.2)

late (≥1 mo) 3(8.3)

ileus operation(adhesiolysis) 1 (2.7)

paroxysmal bellyache conservative 2(5.6)

Table 3 Postoperative patients’ satisfaction

Degree of satisfaction No.(%)

a great satisfaction 25(69.4)

satisfaction 5(13.9)

basically satisfaction 6(16.7)

poor 0(0)

ClinicalTrials.gov ID:NCT02147574