Therapeutic effect and long-term follow-up of the Jinling procedure for refractory constipation: a series of 1 100 cases / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the safety, effectiveness and long-term results of Jinling procedure.</p><p><b>METHODS</b>A total of 1 100 patients with refractory constipation were admitted to the Institute of General Surgery between February 2000 and December 2013 and received Jinling procedure. There were 217 male and 883 female patients with an average age of (45±15) years and an average duration of (275±159) months. The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis. The general clinical data, postoperative complications, gastrointestinal quality of life index (GIQLI), Wexner constipation score, satisfaction rate, body composition, nutritional status, homeostasis, anal manometry and defecography during follow-up were collected. Statistical analysis was performed by t-test analysis, χ(2) test or Fisher's exact probability.</p><p><b>RESULTS</b>The postoperative follow-up rate were 96.73%, 94.36%, 93.00% and 92.55% at 1, 3, 6, and 12 months. The satisfaction rate were 62.50%, 72.45%, 93.16% and 94.70% respectively during 1, 3, 6 and 12 months follow-up. The postoperative 1 month, GIQLI was lower than that of preoperative (P=0.038), but significantly better at postoperative 3 month than the preoperative (P=0.022), and gradually improve after then. Wexner score was significantly lower at postoperative 1 month than the preoperative (P=0.018), and with the gradually reduce. Compared to the preoperative baseline, all body composition and serum protein parameters decreased significantly at the one-month follow-up and then increased gradually over the remaining follow-up period. Weight and prealbumin were significantly higher than the preoperative at postoperative 12 month. Jinling procedure had no effect on electrolytes. All patients were detected in defecography before surgery, but these abnormal indicators were improved after surgery. Anal function, coordinated movement anorectal function, anorectal reflex and rectal sensation were injured at early postoperative, but as time goes on, these indicators gradually returned to preoperative levels, some indicators better than the preoperative level. Postoperative surgical site infection, anastomotic bleeding , anastomotic leakage, urinary retention, sexual dysfunction, recurrent constipation, bowel obstruction, anastomotic stricture and mortality rates were 4.36%, 5.45%, 6.00%, 6.91%, 0.64%, 0.45%, 8.82%, 4.00% and 0.27% respectively.</p><p><b>CONCLUSIONS</b>Jinling procedure is a safe and effective surgical procedure for refractory constipation. It can improve defecation function and quality of life significantly, and has a high follow-up satisfaction rate.</p>