Laparoscopic treatment of chronic slow transit constipation Report of three cases and review of literature

INTRODUCTION: The Authors present their experience with laparoscopic total or subtotal colectomy (TC or SC) in three patients operated for intractable chronic slow transit constipation (STC), together with a review of literature. MATERIAL AND METHODS: From July 2005 to July 2009 three young patients affected by STC, after meticulous preoperative instrumental work-up and after failure of medical treatment, were submitted to laparoscopic TC and Ideo Rectal Anastomosis (IRA) in two cases and to laparoassisted SC followed by Ceco Rectal Anastomosis (CRA) in one case. Number of daily bowel motions, urgency soiling, incontinence, abdominal pain, bloating with special regard to patient's quality of life, were analyzed. RESULTS: All the interventions were completed via laparoscopic approach. No postoperative morbidity or mortality were observed. After twelve months, the patients referred two-three daily evacuation of soft stool, with a good continence and disappearance of abdominal pain and other relatives symptoms. They reported excellent satisfaction with the surgical results and a significant improvement of their quality of life. DISCUSSION: TC with IRA and CRA after SC represent the most effective and widely used surgical operations in the treatment of STC, in well selected patients, after failure of conservative treatment. According to Literature data, and in our experience, no significant differences in terms of postoperative morbidity or mortality neither in quality of life were observed between the two operations. It is well demonstrated the feasibility of the laparoscopic approach in treatment of colorectal pathologies with typically advantages of less invasive surgery, respect of parietal integrity, less postoperative pain and ileus, fewer postoperative adhesions, a reduced hospitalisation and finally a better cosmesis. CONCLUSIONS: Laparoscopic TC and IRA and CRA after laparoassisted SC represent efficacious operations in the treatment of STC offering a good postoperative quality of life and reduced morbidity compared to open surgery.