Laparoscopy assisted with transanal endoscopic microsurgery in the treatment of severe functional constipation

Objective To investigate the feasibility and efficacy of laparoscopic subtotal colectomy and modified Duhamel procedure combined with transanal endoscopic microsurgery (TEM)in the treatment of severe functional constipation (SFC). Methods The clinical data of 10 patients with SFC treated by laparoscopic surgery combined with TEM between May 2010 and October 2012 in Ruijin Hospital of Shanghai Jiaotong University School of Medicine were retrospectively analyzed. The gastrointestinal quality of life index (GIQLI), Wexner constipation scale and daily frequency of defecation postoperatively during follow-up were collected. Results All the 10 operations were successfully accomplished laparoscopic subtotal colectomy combined with TEM without abdominal incision. There was no conversion to open procedure. One case had preventive terminal ileum stoma. The mean operative time was (256±58)min. The mean blood loss was (178±67)ml. The mean time to first flatus was (40±11)h. There were no ureteric injury, anastomotic leak, pelvic sepsis and other complications postoperatively. There was one case of insufficient small bowel obstruction which was released by conservative treatments. The patients were discharged from the hospital in (9.0±1.5)d postoperatively. The GIQLI in one year postoperatively was (112 ± 10)points, which indicated good results compared to (75 ± 12)points preoperatively (P=0.000). The Wexner constipation scale was 20.8±2.2 preoperatively and decreased to 5.2±1.8 at one year follow-up (P=0.000). Conclusion Laparoscopic subtotal colectomy and modified Duhamel procedure combined with TEM provides SFC patients a safe and feasible minimally invasive surgery. Key words: Severe functional constipation; Surgical procedures; Laparoscopy; Transanal endoscopic microsurgery