Ileorectal Intussusception Compared with End-to-end Ileorectal Anastomosis Following Laparoscopic Total Colectomy in Slow Transit Constipation：a Retrospective Cohort

Abstract

Abstract Background Although end-to-end ileorectal anastomosis (EEIRA) followed total colectomy is the most effective surgical treatment for slow transit constipation (STC), but frequent diarrhea and urgent defecation have not been solved for more than 6 months after surgery. This study aimed to compare the defecating frequency, surgical complications, and quality of life after ileorectal intussusception anastomosis (IRIA) or EEIRA following laparoscopic total colectomy in STC. Methods This is a prospectively collected and retrospectively analyzed the data of 100 consecutive STC patients treated by 1 medical team in Tianjin Union Medical Center from August 2016 to July 2021. There were 70 cases underwent IRIA and 30 cases underwent EEIRA. The incidence and mortality of postoperative complications, gastrointestinal quality of life score（GIQLI）and fecal incontinence quality of life score（FIQL）were followed up after operation at median 3 years. The frequency of defecation, use of antidiarrheal drugs, Wexner constipation score follow-up at 1 year. Results A total of 100 patients(83 females and 17 males) were enrolled, and no death. Follow-up a year, there was more than 10 defecating frequency for 19 patients (19/30, 63,33%) in EEIRA group after operation. At 7 days, 1 month, 2 months, 3 months, 6 months after operation, and there were statistically significant difference in IRIA group for the reduction of defecation times compared with EEIRA (all P < 0.05); After 12 months of follow-up, there was no significant difference in the frequency of defecation between the two groups (P= 0.25); ANVOA analysis of variance showed that the number of defecation significantly decreased in IRIA group compared with EEIRA group F（5，490）= 193.09，(P = 0.00). Follow-up at median 3 years, there were prevalencesignificant difference in short-term and long-term complications between IRIA and EEIRA group, respectively (9/70, 12.86%) vs. (11/30, 36.67%)（P =0.03）, and (6/70, 8.57%) vs. (8/30, 26.67%)（P =0.01）. IRIA group were better than those of EEIRA group for FIQL and GIQLIscores follow-up at median 3 years, respectively (112.56 ± 8.25) vs. 105.14 ± 20.74)(P = 0.03), and (170.58 ± 8.24) vs. (164.00 ± 15.15)，(P = 0.01) . Conclusion Follow-up at median 3 years, IRIA has a lower prevalence of surgical complications than EEIRA in the treatment of STC and significantly improve the quality of life, which can reduce the frequency of defecation within 1 year of follow-up.