Feasibility of the Laparoscopic Total Colectomy with Ileal j-Pouch-Rectal Anastomosis in the Treatment of Chronic Constipation Refractory to Medical Therapy: Observations about a Case Report

Abstract

In October 2012, a 29-year-old woman affected by chronic constipation underwent surgery for a laparoscopic total colectomy with ileal j-pouch-rectal anastomosis. After a precise instrumental work-up, the patient was selected as a potential candidate for the surgical treatment after failing to respond to all other medical treatment. During the first three months following the surgery, the patient recorded 3 - 4 daily evacuations of soft stool. After the third month, the number of evacuations stabilised at 2 3 a day, with formed stool, and no mention of incontinence or abdominal pain. Although the laparoscopic total colectomy with ileorectal anastomosis (TC with IRA) and the laparoscopically assisted subtotal colectomy with cecorectal anastomosis (SC with CRA) are the most frequently practiced procedures in the surgical treatment of chronic constipation, the laparoscopic colectomy with ileal j-pouch has shown in our experience to be a feasible and effective procedure, with similar results to the two aforementioned procedures in terms of morbidity, mortality and quality of life. In fact, like the first two, the total colectomy with ileal j-pouch has demonstrated the advantages of laparoscopic surgery: low invasiveness, less post-operative pain or ileus, respect of parietal integrity, reduced hospitalization and, lastly, a better cosmesis.

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A. Allaria, V. Napolitano, M. Bondanese, F. Moccia, M. Cimmino, B. Pascotto, F. Orlando and L. Fei, "Feasibility of the Laparoscopic Total Colectomy with Ileal j-Pouch-Rectal Anastomosis in the Treatment of Chronic Constipation Refractory to Medical Therapy: Observations about a Case Report," Surgical Science, Vol. 4 No. 9, 2013, pp. 377-379. doi: 10.4236/ss.2013.49074.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. F. Piccirillo, P. Reisman and S. D. Wexner, “Colectomy as Treatment for Constipation in Selecte Patients,” British Journal of Surgery, Vol. 82, No. 7, 1995, pp. 899-901.
[2] M. El-Shaly, “Chronic Idiopatic Slow Transit Constipation: Pathophysiology and Management,” Colorectal Disease, Vol. 5, No. 4, 2003, pp. 288-296. doi:10.1046/j.1463-1318.2003.00498.x
[3] G. Conzo, A. Allaria, F. Stanzione, G. Rossetti, G. Candela, C. Mauriello, L. Fei and L. Santini, “Laparoscopic Treatment of Chronic Slow Transit Constipation. Report of Three Cases and Review of Literature,” Annali Italiani di Chirurgia, Vol. 83, No. 2, 2012, pp. 113-117.
[4] M. Candelli, E. C. Nista, M. A. Zocco and A. Gasbarrini, “Idiopatic Chronic Constipation. Pathophysiology, Diagnosis and Treatment,” Hepato-Gastroenterology, Vol. 48, No. 40, 2001, pp. 1050-1057.
[5] A. Wald, “Constipation,” Medical Clinics of North America, Vol. 84, No. 4, 2000, pp. 1231-1246. doi:10.1016/S0025-7125(05)70284-4
[6] C. H. Knowles, S. M. Scott and P. J. Lunniss, “Slow Transit Constipation: A Disorder of Pelvic Autonomic Nerve?” Digestive Diseases and Sciences, Vol. 46, No. 3, 2001, pp. 389-401. doi:10.1023/A:1005665218647
[7] W. R. Schouthen, F. J. W. ten Kate, E. J. R. de Graaf, E. C. A. M. Gilberts, J. L. Simons and P. Kluck, “Visceral Neuropathy in Sloe Transit Constipation: An Immunohistochemical Investigation with Monoclonal Antibodies against Neurofilament,” Diseases of the Colon & Rectum, Vol. 36, No. 12, 1993, pp. 1112-117. doi:10.1007/BF02052258
[8] M. El-Salhy and O. Norrgard, “Colonic Neuroendocrine peptide Levels in Patients with Chronic Idiopathic Slow Transit Constipation,” Upsala Journal of Medical Sciences, Vol. 103 No. 3, 1998, pp. 223-230. doi:10.3109/03009739809178951
[9] D. C. Nyam, J. H. Pemberton, D. M. Ilstrup and D. M. Rath, “Long Term Results of Surgery for Chronic Constipation,” Diseases of the Colon & Rectum, Vol. 40, No. 3, 1997, pp. 273-79. doi:10. 1007/BF02050415
[10] R. M. Mollen, H. C. Kuijpers and T. Claassen, “Colectomy for Slow-Transit Constipation: Preoperative Functional Evaluation Is Important But Not a Guarantee for a Successful Outcome,” Diseases of the Colon & Rectum, Vol. 44 No. 4, 2001, pp. 577-80. doi:10.1007/BF02234332
[11] F. Marchesi, L. Sarli, L. Percalli, G. E. Sansebastiano, L. Veronesi, D. Di Mauro, C. Porrini, M. Ferro and L. Roncoroni, “Subtotal Colectomy with Antiperistaltic Cecorectal Anastomosis in the Treatment of Slow-Transit Constipation: Long-Term Impact on Quality of Life,” World Journal of Surgery, Vol. 31, No. 8, 2007, pp. 1658-1664. doi:10.1007/s00268-007-9111-6
[12] C. Q. Jiang, Q. Qian, Z. S. Liu, G. Bangoura, K. Y. Zheng and Y. H. Wu, “Subtotal Colectomy with Antiperistaltic Cecoproctostomy for Selected Patients with Slow Transit Constipation-From Chinese Report,” International Journal of Colorectal Disease, Vol. 23, No. 12, 2008, pp. 1251-1256. doi:10.1007/s00384-008-0552-7
[13] R. Levitan, S. J. Fordtran, B. A. Burrows and F. J. Ingelfinger, “Water and Sale Absorbation in Humane Colon,” Journal of Clinical Investigation, Vol. 41, No. 9, 1962, pp. 273-279.

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