Laparoscopic subtotal colectomy with antiperistaltic ceco-rectal anastomosis: a new step in the treatment of slow-transit constipation

Background: Subtotal colectomy with antiperistaltic ceco-rectal anastomosis (SCCRA) has proved to be an effective alternative to total colectomy for the treatment of severe slow-transit constipation. The laparoscopic approach has made this procedure even more attractive. This is the first controlled trial on laparoscopic SCCRA: the study compares the laparoscopic and the open approach. Methods: Since 2001 all SCCRAs have been performed laparoscopically at our institution. Only severely symptomatic patients are offered surgery, after stringent patient selection. Laparoscopic SCCRA was carried out following the same steps we first described for the open approach, by utilizing a 5-trocar technique. Outcome parameters were prospectively collected every 3 and 6 months. Wexner constipation and incontinence scales (WCS, WI) and gastrointestinal quality of life index (GIQLI) were adopted for functional results. We conducted a case-control study of 15 consecutive patients who underwent laparoscopic SCCRA (VL) and 15 patients previously operated on by the open approach (Op) to compare post-operative and functional outcomes. Results: Complication rates were similar. The VL group had better postoperative outcomes (pain, ileus) resulting in a significantly shorter hospital stay. Resolution of constipation was impressive in both groups, with no significant difference at follow-up. The VL group presented with a higher number of bowel movements at 3 months (3.8 vs 2.8, p=0.039), resulting in a significantly higher incontinence rate at 3 months (WI 6.4 vs 2.73, p= 0.004), although the difference was no longer significant at 1-year follow-up. The quality of life was good for both groups; the VL group showed a significant improvement at 1-year follow-up (64.18 vs 114.79, p< 0.01). Conclusions: Laparoscopic SCCRA confirmed the good functional results of the open approach, with no increase in morbidity rate and a faster postoperative recovery. An early higher incontinence rate did not affect quality of life.