Laparoscopic total colectomy, ileal J-pouch, and ileorectal anastomosis in the treatment of slow transit constipation: a case report (with video)

Objective: To investigate the clinical efficacy of laparoscopic total colectomy, ileal J-pouch, and ileorectal anastomosis (LTC + IRA) in the treatment of slow transit constipation (STC). Methods: The clinical data of six patients with STC who underwent LTC + IRA surgery from January to December 2023 were retrospectively analyzed. Before the operation, colonic transit experiment, fiber colonoscopy, defecography examinations, colography,, and psychological evaluations were performed. The operation time, application of antidiarrheal drugs, and the occurrence of complications were collected. At the 3rd, 6th, and 12th months after surgery, the patients were followed up with the number of daily bowel movements, Wexner constipation score, anal incontinence score, gastrointestinal quality of life index score (GIQLI), abdominal pain frequency score, and abdominal distension frequency score. Results: All patients successfully completed laparoscopic surgery, and they had no complications and were followed up for 1 year. With the extension of postoperative follow-up time, all patients’ defecation and quality of life significantly improved compared with before surgery. The number of daily bowel movements at 3, 6, and 12 months after surgery was significantly higher than before surgery. At 12 months postoperatively, the bowel movement frequency was basically close to normal. Wexner’s constipation score, anal incontinence score, GIQLI score, abdominal pain frequency score, and abdominal distension frequency score were significantly improved compared with before surgery. The quality of life of all patients had significantly improved, and they were satisfied. Conclusion: On the premise of strictly adhering to the indications for surgery, LTC + IRA were safe, effective, and feasible for the treatment of STC, which is less invasive and has faster recovery.