Long-term follow-up of the Jinling procedure for combined slow-transit constipation and obstructive defecation.

Abstract

BACKGROUND:

Surgery is indicated for chronic constipation refractory to conservative therapy. The treatment of combined slow-transit constipation and obstructive defecation is controversial.

OBJECTIVE:

The aim of the study is to describe the Jinling procedure and examine safety, effectiveness, and quality of life over 4 years of follow-up.

DESIGN:

The study is a retrospective review of prospectively gathered data in a patient registry database.

SETTINGS:

This investigation was conducted at a tertiary-care gastroenterology surgical center in China.

PATIENTS:

The study included 117 consecutive patients with slow-transit constipation combined with obstructive defecation treated between January 2005 and December 2007.

INTERVENTION:

The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis to solve the coexistence of obstructive defecation and slow-transit constipation in one operation.

MAIN OUTCOME MEASURES:

We measured morbidity and mortality rates, Wexner constipation scores, and Gastrointestinal Quality of Life Index at baseline and after 1, 6, 12, 24, 36 and 48 months of follow-up.

RESULTS:

A total of 117 patients underwent the Jinling procedure, which was laparoscopically assisted in 56 patients (47.9%) and an open procedure in 61 patients (52.1%). Of the total, 72 patients (61.5%) had undergone previous surgical intervention without improvement. A total of 28 complications and adverse events were reported in 117 procedures, giving an overall morbidity rate of 23.9%; 23 patients (19.7%) had 1 or more events. Most complications were managed conservatively. A significant reduction in Wexner constipation score was observed from baseline (mean, 21.9) to 1 month (mean, 9.8), and the reduction was maintained at 48 months (mean 5.1; p < 0.001). Compared with baseline, significant overall improvements were also seen in gastrointestinal quality of life at 12, 24, and 48 months of follow-up (p < 0.01).

LIMITATIONS:

This study did not include a comparison group.

CONCLUSIONS:

Our clinical practice demonstrates that Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after 4-year follow up.

• Authors: Ning Li, Jun Jiang, Xiaobo Feng, Weiwei Ding, Jianlei Liu, Jieshou Li
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 56 Issue 1 Pg. 103-12 (Jan 2013) ISSN: 1530-0358 [Electronic] United States
• PMID: 23222287 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Anastomosis, Surgical (adverse effects, methods)
• China (epidemiology)
• Colectomy (adverse effects, methods)
• Colon (physiopathology, surgery)
• Constipation (complications, diagnosis, physiopathology, psychology, therapy)
• Defecation (drug effects)
• Drug Resistance
• Fecal Impaction (complications, diagnosis, physiopathology, psychology, therapy)
• Female
• Gastrointestinal Motility (drug effects)
• Humans
• Laparoscopy (adverse effects, methods)
• Male
• Manometry (methods)
• Patient Preference
• Quality of Life
• Registries
• Reoperation
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome