Anti-peristaltic Ileo-sigmoid Anastomosis for the Treatment of Slow-transit Constipation:Therapeutic Evaluation
Condition: Constipation
MeSH terms: Constipation
Study type: Interventional
Phase: Phase 4

Summary: 
      Purpose:

      To evaluate the curative effect of Laparoscope Sub-total Colectomy with Anti-peristaltic
      ileosigmoid anastomosis for the treatment of slow-transit constipation on the patients with
      STC.

      Methods and techniques:

      The data of patients with STC preformed surgery of laparoscopic subtotal colectomy with
      anti-peristaltic ileosigmoid anastomosis during 2009.01-2014.05 was reviewed. The related
      status such as frequency of defecation, course of constipation, laxatives use condition the
      condition of using laxatives, and changes in weight were investigated. Changes of defecation
      and weight, periprocedural complications (wound infection, lung infection and intestinal
      fistula), long-term complication (malnutrition, abdominal pain, ileus), life satisfaction,
      wexner score of pre-operation and postoperation ect were investigated in follow-ups.
    

Detailed description: 
      Theoretical Basis:

      As far as the current research status, total colectomy or subtotal colectomy has become the
      preferred type of surgery for slow-transit constipation treatment. There are different
      opinions on intestinal anastomosis and the specific scope of excision. There is a type of
      surgery reserving the ileocecum, as the ileocaecal valve has the function of postponing the
      fecal evacuation. There's also a type of surgery excising the ileocecum , and establishing
      the pouch, as reserving the ileocecum may cause the recurrence of constipation, and
      establishing the pouch has function of relieving the postoperative fecal incontinence. On the
      basis, our own type of surgery is designed; ileocecum is excised for preventing the
      recurrence of constipation, while the anti-peristaltic ileosigmoid anastomosis between the
      small intestine and part of sigmoid is made for preventing the severe diarrhea.

      Methods and techniques:

      The data of patients with STC preformed surgery of laparoscopic subtotal colectomy with
      anti-peristaltic ileosigmoid anastomosis during 2009.01-2014.05 was reviewed. The related
      status such as frequency of defecation, course of constipation, laxatives use condition the
      condition of using laxatives, and changes in weight were investigated. Changes of defecation
      and weight, periprocedural complications (wound infection, lung infection and intestinal
      fistula), long-term complication (malnutrition, abdominal pain, ileus), life satisfaction,
      wexner score of pre-operation and postoperation ect were investigated in follow-ups.

      Surgical operation process:

      1,Laparoscope Sub-total Colectomy： After the entire colon mobilization,the ileum is resected
      at 10cm from ileocecum and 10-15cm colon up to peritoneal reflection is reserved. The
      ileocolic artery should be reserved carefully.2, Intestinal tract reconstruction: The
      terminal ileum is turned over 180°in anti-clockwise direction along the superior mesenteric
      vein long axis. To avoid the small mesenteric torsion, we should turn the broken edge towards
      inside. The terminal ileum and 10-15cm colon anastomose in anti-peristaltic direction,the
      anastomotic length is 8-10 cm.3, Sewn the space between anastomotic Intestine and posterior
      peritoneum. A drain is placed in the abdominal cavity and another one is placed in anal
      canal.
    

Intervention name(s): Anti-peristaltic ileosigmoid anastomosis
Intervention type(s): Procedure
Intervention description(s): 1,Laparoscope Sub-total Colectomy： After the entire colon mobilization,the ileum is resected at 10cm from ileocecum and 10-15cm colon up to peritoneal reflection is reserved. The ileocolic artery should be reserved carefully.2, Intestinal tract reconstruction: The terminal ileum is turned over 180°in anti-clockwise direction along the superior mesenteric vein long axis. To avoid the small mesenteric torsion , we should turn the broken edge towards inside. The terminal ileum and 10-15cm colon anastomose in anti-peristaltic direction,the anastomotic length is 8-10 cm.3, Sewn the space between anastomotic Intestine and posterior peritoneum. A drain is placed in the abdominal cavity and another one is placed in anal canal.
Intervention MeSH terms: Antidiarrheals
Intervention model: Single Group Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: slow-transit constipation; laparoscope Sub-total Colectomy; anti-peristaltic anastomosis