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Subtotal Colectomy with Antiperistaltic Cecorectal Anastomosis in the Treatment of Slow-transit Constipation: Long-term Impact on Quality of Life

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Abstract

Background

The aim of the study was to evaluate the effectiveness of subtotal colectomy with cecorectal anastomosis (SCCA) in the treatment of slow-transit constipation, not just in terms of symptom resolution but also the overall impact on patients’ quality of life.

Methods

Between 1991 and 2005, 43 patients underwent SCCA at our institution, 22 for slow-transit constipation (STC) and 21 for other types of colic diffuse disease (non-slow-transit constipation: NSTC), the latter being considered controls. A total of 29 patients (17 affected by STC) were administered a 50-item telephonic questionnaire, including the Gastrointestinal Quality of Life Index (GIQLI), the Wexner constipation and incontinence scale (WC, WI), and individual willingness to repeat the procedure. Questionnaire data and other parameters such as age, sex, length of follow-up, complications, and length of hospital stay were analyzed and compared, in order to evaluate possible correlations between the parameters and their related impact on quality of life, procedural effectiveness in terms of symptomatic regression, qualitative differences related to pathology (constipation versus non-constipation), and surgical approach (laparotomy versus video-laparo-assisted procedure).

Results

There were no procedure-related deaths in this series (mortality: 0%); however, we found two complications in the STC group (9.1%), one requiring reoperation. The GIQLI mean score for the STC group was 115.5 ± 20.5 (mean score for healthy people 125.8 ± 13), and the WC mean score passed from a preoperative value of 20.3 to a postoperative value of 2.6. Regression analysis revealed a significant correlation between GIQLI and urgency and abdominal pain, and abdominal pain correlated significantly with pathology (STC). A high number of patients (88.2% in STC) expressed a willingness to repeat the procedure given the same preoperative conditions.

Conclusions

Comparing our results to those of the most homogeneous literature data, SCCA does not appear to be inferior to subtotal colectomy with ileorectal anastomosis (IRA) in terms of therapeutic effectiveness, postoperative mortality and morbidity, or overall impact on quality of life.

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Authors and Affiliations

  1. Department of Surgical Sciences, Section of General Surgical Clinics and Surgical Therapy, Parma University Medical School, Parma, Italy

    Federico Marchesi, Leopoldo Sarli, Luigi Percalli, Davide Di Mauro, Cristina Porrini & Luigi Roncoroni

  2. Department of Public Health, Section of Hygiene, Parma University Medical School, Via Gramsci n.14, 43100, Parma, Italy

    Giuliano Ezio Sansebastiano & Licia Veronesi

  3. Department of Surgery Section of Anesthesiology, Intensive Care and Pain Therapy Parma Hospital, Via Gramsci n.14, 43100, Parma, Italy

    Michelina Ferro

Authors
  1. Federico Marchesi
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  2. Leopoldo Sarli
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  3. Luigi Percalli
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  4. Giuliano Ezio Sansebastiano
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  5. Licia Veronesi
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  6. Davide Di Mauro
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  7. Cristina Porrini
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  8. Michelina Ferro
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  9. Luigi Roncoroni
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Correspondence to Federico Marchesi.

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Marchesi, F., Sarli, L., Percalli, L. et al. Subtotal Colectomy with Antiperistaltic Cecorectal Anastomosis in the Treatment of Slow-transit Constipation: Long-term Impact on Quality of Life. World J Surg 31, 1658–1664 (2007). https://doi.org/10.1007/s00268-007-9111-6

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  • DOI: https://doi.org/10.1007/s00268-007-9111-6

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