Pinedo George, León Francisca, Molina María Elena, Soto Gonzalo, López Francisco, Zúñiga Alvaro
Division of Surgery, Department of Digestive Surgery, Catholic University School of Medicine, Marcoleta 367, Santiago, Chile.
Dis Colon Rectum. 2008 Jan;51(1):139-41. doi: 10.1007/s10350-007-9088-0. Epub 2007 Nov 21.
Slow-transit constipation after proper diagnosis and extensive medical therapy may have a surgical solution. Total abdominal colectomy and ileorectal anastomosis, at our institution, is the surgical procedure of choice. Nonetheless, patients may reject this alternative because of morbidity.
We report two cases of slow-transit constipation diagnosed after a thorough investigation with two colonic transit tests showing slow-transit constipation, a normal anorectal manometry, balloon expulsion test, small-bowel follow-through, defecography, laboratory and psychologic tests. The patients rejected standard surgical treatment (total colectomy + ileorectal anastomosis). A colonic bypass with an ileorectal anastomosis, leaving the colon in situ, was offered and accepted by the two patients. This was performed laparoscopically liberating the cecum and terminal ileum, transecting the terminal ileum through a small suprapubic incision, and anastomosing the terminal ileum to the rectosigmoid junction intracorporeally. The total surgical time was 50 and 60 minutes, respectively. Both patients made uneventful recoveries and were discharged on the fourth postoperative day. They have completed four and two months of close follow-up and at present have one to four bowel movements per day with mild abdominal distension and pain. To our knowledge this is the first report of colonic bypass for the treatment of slow-transit constipation.
经过正确诊断和广泛药物治疗后，慢传输型便秘可能有手术解决方案。在我们机构，全腹结肠切除术和回肠直肠吻合术是首选的手术方式。然而，患者可能因手术并发症而拒绝这种选择。
我们报告两例慢传输型便秘患者，经过全面检查，两项结肠传输试验显示为慢传输型便秘，同时肛门直肠测压、气囊排出试验、小肠造影、排粪造影、实验室及心理测试均正常。患者拒绝了标准手术治疗（全结肠切除术+回肠直肠吻合术）。我们为这两名患者提供并实施了保留结肠原位的回肠直肠吻合结肠旁路手术。该手术通过腹腔镜游离盲肠和回肠末端，经耻骨上小切口横断回肠末端，然后在体内将回肠末端与直肠乙状结肠交界处吻合。手术总时间分别为50分钟和60分钟。两名患者术后恢复顺利，均于术后第4天出院。他们已分别完成了4个月和2个月的密切随访，目前每天有1至4次排便，伴有轻度腹胀和疼痛。据我们所知，这是首例关于结肠旁路手术治疗慢传输型便秘的报道。
