Natural orifice specimen extraction approach for laparoscopic Jinling procedure in refractory mixed constipation (with video)

Jinling surgery is an effective surgical approach for treating constipation, distinguished by its unique anastomosis technique. The circular stapler is introduced through the posterior wall of the rectal stump, approximately 1.5 cm above the dentate line. An end-to-side retrocolorectal anastomosis is then performed, utilizing a purse string to secure the anvil of the circular stapler to the ascending colon stump. Subsequently, two arms of the linear cutter are inserted into the rectum and ascending colon, respectively, to facilitate the widening of the anastomosis. The removal of the specimen through the natural orifice complicates the procedure; therefore, it is essential to insert the 25 mm stapler rack from the anus into the rectum while protected by an endoscopic cover. With the endoscopic protective cover in place, the colon specimen is then pulled through the remaining segment of the rectum and out of the anus. The patient recovered without any significant complications. They experienced exhaustion for three days following the operation and were placed on a liquid diet for five days. The drainage tube was removed after seven days, and the patient was successfully discharged nine days post-surgery. Notably, there were significant long-term improvements in both the gastrointestinal quality of life index and the Wexner stool score following the procedure. In summary, the Jinling procedure utilizing natural orifice specimen extraction surgery is safe and feasible for refractory constipation.