Laparoscopic-assisted compared with open total colectomy in treating slow transit constipation

Background: Total colectomy is the procedure of choice as;hen slow transit constipation (STC) can be confidently diagnosed. A laparoscopic-assisted technique (LTC) may be potentially advantageous over traditional open technique (OTC) in the treatment of this benign condition. Methods: A historical control (non-randomized) study was performed on patients diagnosed to have STC after clinical, anorectal physiologic and transit marker studies. All earlier consecutive patients underwent OTC and the latter consecutive patients underwent LTC. The intra-operative time, blood loss. postoperative ileus recovery, duration of hospitalization and complications were recorded. A bowel function and patient satisfaction questionaire was administered on follow-up. Results: Twenty-four of 411 patients were found to have STC; 17 (2 men, 15 women: mean age, 40 (standard error of mean [SEM] 5) years) under went OTC and 7 (2 men, 5 women; mean age, 39.5 (SEM 6) years) underwent LTC. There were significant improvements in the stool frequency, need for assisted evacuation and abdominal distension (P < 0.05) after both procedures 96% were fully satisfied with the resulting bowel function. However, OTC patients were less satisfied with the cosmetic outcome (P < 0.05). Intra-operative time far LTC was longer by a mean 74 min (P < 0.05). Postoperative blood loss, recovery of ileus and hospitalization time were the same in both groups. There were no deaths. The complication rates were 43% for LTC and 24% for OTC. The predominant complication was bowel obstruction for which two patients (both OTC) required adhesiolysis. Conclusions: Both OTC and LTC improve bowel function for STC: LTC gives a better cosmetic result, but takes longer to perform.