Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e318273a182
Original Contribution: Pelvic Floor

Long-term Follow-up of the Jinling Procedure for Combined Slow-Transit Constipation and Obstructive Defecation

Li, Ning M.D.; Jiang, Jun M.D.; Feng, Xiaobo M.D.; Ding, Weiwei M.D.; Liu, Jianlei M.D.; Li, Jieshou M.D.

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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.

© The ASCRS 2013


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