Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation.

Background: Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation (STC), despite the increase in the number of cases. This study aimed to analyse the long-term surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis (SC-ACRA) vs total colectomy with ileorectal anastomosis (TC-IRA) for severe STC.

Methods: Between January 2005 and January 2015, we retrospectively collected clinical data of 55 patients who underwent TC-IRA (=35) or SC-ACRA (=20) for severe STC at our institution. The post-operative functional outcomes between the two groups were compared.

Results: There were no significant differences in age (=0.655), sex (=0.234), period of constipation (=0.105) and defecation frequency (=0.698) between the TC-IRA and SC-ACRA groups. During a median follow-up period of 72 months (range, 12-120 months), there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day [3 (1/6-7) vs 3 (1/6-5), =0.578], Cleveland Clinic Florida Constipation Score [2 (0-20) vs 2 (0-19), =0.454], Cleveland Clinic Incontinence Score [0 (0-5) vs 0 (0-2), =0.333] and Gastrointestinal Quality of Life Index [122 (81-132) vs 120 (80-132), =0.661]. Moreover, there was no significant difference in the incidence of post-operative complications between the two groups (37.1% vs 25.0%, =0.285).

Conclusions: Our findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC, with similar long-term outcomes.