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Novel surgery for refractory mixed constipation: Jinling procedure - technical notes and early outcome.

Ding W, Jiang J, Feng X, Yao A, Wang L, Li J, Li N - Arch Med Sci (2014)

Bottom Line: A total of 39 complications and adverse events were reported in 22 patients (morbidity rate of 24.4%).Most complications were managed conservatively without significant events.The pelvic floor, especially the presacral space, is damaged, and therefore it may be unsalvageable if severe complications, such as anastomosis leakage or ischemia, occur.

View Article: PubMed Central - PubMed

Affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.

ABSTRACT

Introduction: The treatment of slow-transit constipation combined with outlet obstruction is controversial. This study introduced a new surgical strategy, subtotal colectomy combined with a modified Duhamel procedure (Jinling procedure), of which the safety and satisfactory rate were examined.

Material and methods: Ninety patients with refractory slow-transit constipation associated with outlet obstruction were consecutively included between Jan 2010 and Dec 2010. All underwent the laparoscopic-assisted Jinling procedure, which added a new side-to-side anastomosis to the colorectal posterior anastomosis after subtotal colectomy. The pre- and post-operative data were collected.

Results: There was no surgery-related death. A total of 39 complications and adverse events were reported in 22 patients (morbidity rate of 24.4%). Most complications were managed conservatively without significant events. The satisfactory rate was 93.1% at 6-month follow-up.

Conclusions: The Jinling procedure is safe for refractory slow-transit constipation associated with outlet obstruction, with minimal major complications and a high satisfaction rate. However, this procedure requires rigorous preoperative examination, exquisite surgical and laparoscopic techniques and excellent perioperative management. The pelvic floor, especially the presacral space, is damaged, and therefore it may be unsalvageable if severe complications, such as anastomosis leakage or ischemia, occur.

No MeSH data available.


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The resection range of the Jinling procedure: subtotal colectomy and appendectomy
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Figure 0001: The resection range of the Jinling procedure: subtotal colectomy and appendectomy

Mentions: An increasing number of patients with constipation suffer from STC associated with concomitant ODS [6]. Of 541 cases of chronic constipation, reported by Ragg [6], nearly one third were classified as outlet obstruction plus STC. Most patients with STC have associated outlet obstruction [6]. The optimal treatment of patients with combined STC and ODS is still unclear. Solely stapled transanal rectal resection (STARR) or colectomy with ileorectal anastomosis could not resolve the coexisting problems [1, 7]. Inspired by the modified Duhamel operation, in this study we introduced a new surgical procedure, named the Jinling procedure after our hospital, to treat mixed constipation (Figure 1). The whole surgical procedure is described in detail in this study.


Novel surgery for refractory mixed constipation: Jinling procedure - technical notes and early outcome.

Ding W, Jiang J, Feng X, Yao A, Wang L, Li J, Li N - Arch Med Sci (2014)

The resection range of the Jinling procedure: subtotal colectomy and appendectomy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296070&req=5

Figure 0001: The resection range of the Jinling procedure: subtotal colectomy and appendectomy
Mentions: An increasing number of patients with constipation suffer from STC associated with concomitant ODS [6]. Of 541 cases of chronic constipation, reported by Ragg [6], nearly one third were classified as outlet obstruction plus STC. Most patients with STC have associated outlet obstruction [6]. The optimal treatment of patients with combined STC and ODS is still unclear. Solely stapled transanal rectal resection (STARR) or colectomy with ileorectal anastomosis could not resolve the coexisting problems [1, 7]. Inspired by the modified Duhamel operation, in this study we introduced a new surgical procedure, named the Jinling procedure after our hospital, to treat mixed constipation (Figure 1). The whole surgical procedure is described in detail in this study.

Bottom Line: A total of 39 complications and adverse events were reported in 22 patients (morbidity rate of 24.4%).Most complications were managed conservatively without significant events.The pelvic floor, especially the presacral space, is damaged, and therefore it may be unsalvageable if severe complications, such as anastomosis leakage or ischemia, occur.

View Article: PubMed Central - PubMed

Affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.

ABSTRACT

Introduction: The treatment of slow-transit constipation combined with outlet obstruction is controversial. This study introduced a new surgical strategy, subtotal colectomy combined with a modified Duhamel procedure (Jinling procedure), of which the safety and satisfactory rate were examined.

Material and methods: Ninety patients with refractory slow-transit constipation associated with outlet obstruction were consecutively included between Jan 2010 and Dec 2010. All underwent the laparoscopic-assisted Jinling procedure, which added a new side-to-side anastomosis to the colorectal posterior anastomosis after subtotal colectomy. The pre- and post-operative data were collected.

Results: There was no surgery-related death. A total of 39 complications and adverse events were reported in 22 patients (morbidity rate of 24.4%). Most complications were managed conservatively without significant events. The satisfactory rate was 93.1% at 6-month follow-up.

Conclusions: The Jinling procedure is safe for refractory slow-transit constipation associated with outlet obstruction, with minimal major complications and a high satisfaction rate. However, this procedure requires rigorous preoperative examination, exquisite surgical and laparoscopic techniques and excellent perioperative management. The pelvic floor, especially the presacral space, is damaged, and therefore it may be unsalvageable if severe complications, such as anastomosis leakage or ischemia, occur.

No MeSH data available.


Related in: MedlinePlus