Single-incision clipless laparoscopic total colectomy for intractable slow transit constipation: a single surgeon’s experience

In our institution, patients with intractable slow transit constipation (STC) have undergone single-incision clipless laparoscopic total colectomy (SCLTC) with ileorectal anastomosis (IRA) since 2011. We aimed to examine the feasibility and usefulness of SCLTC with IRA for patients with intractable STC.From January 2011 to December 2018, twenty-two patients with intractable STC underwent SCLTC with IRA at Kashiwa Hospital, Jikei University, by a single surgeon, were retrospectively registered in this study. They consisted of the first 12 consecutive patients undergoing the double stapling technique (DST) with IRA (DST group) and the last 10 consecutive patients undergoing functional end-to-end anastomosis (FEEA) with IRA (FEEA group).The median surgical time was 185 (150-249) min for the FEEA group and 230 (180-266) min for the DST group. A significant difference was identified between the two groups (0.035). There were no significant differences between the groups with respect to the median age, sex, body mass index, constipation type, intraoperative blood loss, postoperative hospital stay, or no use of laxatives daily stool frequency 1 month after surgery. No postoperative complications, such as anastomotic leakage, bowel obstruction, or bleeding related to vessel sealing device, were encountered in either group more than 3 years after surgery.Our results suggest that SCLTC with IRA is feasible and safe for patients with intractable STC. SCLTC with IRA using FEEA is especially preferred to that using DST for patients with intestinal contents in the rectum that cannot be completely removed by pre- and intraoperative preparation.