Defecation Function and Quality of Life in the Patients Treated With Surgery for Slow Transit Constipation

  • STATUS
    Recruiting
  • End date
    Dec 31, 2025
  • participants needed
    100
  • sponsor
    Third Military Medical University
Updated on 14 May 2022

Summary

Although surgical options for slow transit constipation (STC) have been proven to be a definite treatment, improvements in the associated defecation function and quality of life are rarely studied. This study aims to investigate the effectiveness of total or subtotal colectomy, with respect to short- and long-term defecation function and overall quality of life in 5-year regular follow-up.

Description

Constipation is an ever-growing problem and one of the most common gastrointestinal symptoms, affecting 10-15% of adults in the USA and 8.2% of the general population in China. Slow-transit constipation, representing 15~30% constipated patients, is characterized by a loss in the colonic motor activity. Factors such as increasing age, female sex, physical inactivity, endocrine, metabolism, neurological factors, drug use, and depression are associated with constipation. While most patients with constipation are mild and treated easily by a behavioral and medical way, a minority of patients suffering from long-term intractable symptoms and poor quality of life and showing no response to any medical interventions are ultimately recommended for surgery.

Since the effectiveness of colectomy for constipation was first reported by Lane a century ago, surgical treatment for constipation has been greatly developed[6], including ileorectal anastomosis (IRA), cecorectal anastomosis(CRA), colonic exclusion, antegrade enemas (the Malone procedure), modified Duhamel surgery, and permanent ileostomy. Currently, the main surgical procedures for STC are IRA and CRA, which have been widely confirmed to increase bowel-movement frequency in a huge number of patients. However, the reported outcomes of colectomy are controversial and conflicting.In these studies, lack of prospectively defined follow-up intervals is a general problem. Moreover, long-term outcomes of surgery for STC are rarely reported. Furthermore, negatively persistent symptoms including abdominal pain, bloating, intractable diarrhea, malnutrition, constipation recurrence, fecal incontinence, and intestinal obstruction are not uncommon following surgery, adversely affecting defecation function and quality of life following these procedures.

This study aims to investigate the effectiveness of total or subtotal colectomy, with respect to short- and long-term defecation function and overall quality of life during 5-year regular follow-up.

Details
Condition Defecation Function, Quality of Life
Treatment total colectomy, ileorectal anastomosis
Clinical Study IdentifierNCT04304183
SponsorThird Military Medical University
Last Modified on14 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

The clinical manifestations all met the Roman IV standard for the diagnosis of functional constipation
Patients with severe constipation symptoms were unable to defecate naturally and need laxatives to assist defecation or still unable to defecate
Colonic transport tests showed that the opaque X-ray markers remained more than 20% after 72 hours
All conservative treatment for more than 1 year failed
Patients had a strong desire for surgery, and no other contraindications to surgery

Exclusion Criteria

Megacolon was detected with barium enema examination
Colonoscopy suggested the presence of intestinal organic lesions or a history of colorectal cancer treatment
Gastric and small intestinal transport dysfunction
There are depression, anxiety and other mental symptoms
Constipation type irritable bowel syndrome
History of inflammatory bowel disease
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