Peptide YY release after colectomy in slow transit constipation

Background: The gut hormone peptide YY is abundant in the colonic mucosa. Circulating PYY inhibits gastrointestinal motility and decreases food intake. The aim was to determine whether colectomy decreases PYY release in patients with slow transit constipation. Methods: Plasma PYY concentrations were measured in 10 patients with slow transit constipation before and 3–24 months after total abdominal colectomy with ileorectal anastomosis, and in 8 healthy controls. A liquid meal was infused intraduodenally to stimulate PYY release. Results: Postprandial PYY significantly (P?Conclusion. Despite removal of a major source of PYY‐secreting cells, colectomy with ileorectal anastomosis does not induce major impairment of PYY release in slow transit constipation.     

Hand-assisted laparoscopic total colectomy for slow transit constipation

Purpose Current medical treatments for slow transit constipation (STC) are often ineffective, and total colectomy with ileorectal anastomosis has been the procedure of choice for selected patients with refractory STC. Today, minimally invasive approaches are being utilized in a greater number of procedures as surgeons become more familiar with the techniques involved. The aim of this study was to assess the safety and utility of hand-assisted laparoscopic total colectomy for STC. Method From January 2002 to December 2005, 44 women presented with complaints of intractable constipation and failed to respond to medical treatment. Slow transit constipation was diagnosed after a series of examinations, including a colonic transit test, anal manometry, balloon expulsion test, and barium enema. All eligible patients underwent a hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Main outcome measures included the operative time, conversion to open procedure, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. Result The mean operative time was 197 min (range, 125–295 min). The mean estimated blood loss was 113 ml (range, 100–300 ml). The mean day of first time to flatus was 2 days, and the mean hospital stay was 7.6 days. There was no conversion to an open procedure and no surgical mortality. In the following period, two patients developed intestinal obstruction, which underwent exploratory laparotomy. However, some 39 patients (88.6%) expressed excellent or good in satisfaction. Conclusion Hand-assisted laparoscopic total colectomy could be a safe and efficient technique in the treatment of STC.     

Results of colectomy for severe slow transit constipation

PURPOSE: This study assesses the outcome of a standardized operation performed by two surgeons for severe idiopathic slow transit constipation that was resistant to laxative treatment. METHODS: Fifty-nine consecutive patients, 4 men and 55 women, with a mean age of 42.3 years, underwent colectomy with ileorectal anastomosis. Slow colonic transit was demonstrated in each case. Fifty-two patients were available for follow-up, with median time to follow-up being 42 (range, 3–81) months. RESULTS: Median bowel frequency was 4 per 24 hours. Sixty-nine percent had four or less bowel movements daily. Ten percent used antidiarrheal medication regularly. One patient had a stoma for recurrent severe constipation. Mean continence score was 1.8 (on a scale of 0–20); six patients were incontinent, and four of these six had normal preoperative anal manometry. Fourteen patients (27 percent) had difficulty with rectal evacuation. Preoperative defecating proctography was a poor predictor of postoperative evacuation difficulties. Twenty-seven patients (52 percent) had persisting abdominal pain, but there was a significant improvement in the degree of pain (P <0.00001). Forty-seven patients (90 percent) were satisfied with the outcome of the operation (and would elect to have it done again). Dissatisfied patients had recurrent constipation or diarrhea and incontinence. CONCLUSION: Colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients undergoing surgery for severe constipation with proven slow colonic transit.Supported by the Division of Surgery and the Colorectal Research Fund.Read at the meeting of the Royal Australasian College of Surgeons, Perth, Australia, May 1995.     

腹腔镜结肠次全切除逆蠕动盲肠直肠吻合术治疗结肠慢传输型便秘

目的 探讨腹腔镜结肠次全切除、逆蠕动盲肠直肠吻合术在治疗结肠慢传输型便秘中的临床应用价值.方法 2007年9月至2010年10月对收治的31例结肠慢传输型便秘患者进行腹腔镜结肠次全切除、逆蠕动盲肠直肠吻合术,术后3个月和12个月进行随访,以评定手术效果.结果 全组患者手术均成功,无中转开腹手术,手术时间平均260 min(180～310 min),术中出血量平均60 ml(30～120 ml),术后平均住院日8 d(6～11 d),无吻合口瘘、粘连性肠梗阻、切口及腹腔内感染等手术近期并发症.术后3个月随访,便秘症状明显缓解23例,轻度腹泻5例,腹泻2例,症状轻度复发1例.术后12个月随访,便秘症状明显缓解25例,轻度腹泻5例,症状轻度复发1例.结论 腹腔镜结肠次全切除、逆蠕动盲肠直肠吻合术治疗结肠慢传输型便秘,具有创伤小、术后恢复快的优势,临床安全有效,值得临床运用.     

Comparison of two types of colectomy in treating slow transit constipation with or without melanosis coli

AIM: To compare the follow-up outcomes of ileosigmoidal anastomosis(ISA) and caecorectal anastomosis(CRA) in patients with slow transit constipation(STC) with or without melanosis coli(MC).METHODS: We collected the clinical data of 48 STC patients with or without MC from May 2002 to May 2007.Twenty-six patients underwent CRA(14 with MC) and 22 cases received ISA(14 with MC).A 3-year postoperative follow-up was conducted.RESULTS: CRA improved the quality of life [evaluated by the gastrointestinal quality of life index(GIQLI)] in patients without MC,but was inferior to ISA in stool frequency and Wexner and GIQLI scores for MC patients.In the CRA group,patients with MC suffered worse outcomes than those without MC.CONCLUSION: CRA is more suitable for STC patients without MC; however,for STC patients with MC,ISA is a better choice.     

Preservation of superior rectal artery in laparoscopically assisted subtotal colectomy with ileorectal anastomosis for slow transit constipation

BACKGROUNDSlow transit constipation (STC) has traditionally been considered as a functional disorder. However, evidence is accumulating that suggests that most of the motility alterations in STC might be of a neuropathic etiology. If the patient does not meet the diagnosis of pelvic outlet obstruction and poorly response to conservative treatment, surgical intervention with subtotal colectomy may be effective. The most unwanted complication of the procedure is anastomotic leakage, however, preservation of the superior rectal artery (SRA) may reduce its incidence.AIMTo evaluate the preservation of the SRA in laparoscopically assisted subtotal colectomy with ileorectal anastomosis in STC patients.METHODSThis was a single-center retrospective observational study. STC was diagnosed after a series of examinations which included a colonic transit test, anal manometry, a balloon expulsion test, and a barium enema. Eligible patients underwent laparoscopically assisted total colectomy with ileorectal anastomosis and were examined between January 2016 and January 2018. The operation time, blood loss, time to first flatus, length of hospital days, and incidence of minor or major complications were recorded.RESULTSA total of 32 patients (mean age, 42.6 years) who had received laparoscopic assisted subtotal colectomy with ileorectal artery anastomosis and preservation of the SRA. All patients were diagnosed with STC after a series of examinations. The mean operative time was 151 min and the mean blood loss was 119 mL. The mean day of first time to flatus was 3.0 d, and the mean hospital stay was 10.6 d. There were no any patients conversions to laparotomy. Post-operative minor complications including 1 wound infection and 1 case of ileus. There was no surgical mortality. No anastomosis leakage was noted in any of the patients.CONCLUSIONLaparoscopically assisted subtotal colectomy with ileorectal anastomosis and preservation of the SRA can significantly improve bowel function with careful patient selection. Sparing the SRA may protect against anastomosis leakage.     

肠神经系统与慢传输型便秘

慢传输型便秘(STC)病因未明,多因素与其发病相关.肠神经系统(ENS)可独立调节肠道功能,其在慢传输型便秘中的改变具有重要意义.此文就此予以阐述,为STC临床治疗提供依据.     

Use of polyethylene glycol solution in slow transit constipation

Patients with long-standing functional slow-transit constipation were treated with low daily doses of polyethylene glycol solutions. Bowel frequency, stool consistency and colonic transit time improved markedly during the treatment. No relevant side-effects were reported during the study period.     

慢传输型便秘发病机制的研究进展

慢传输型便秘(STC)病因未明,多种因素如肠神经系统、肠神经递质、胃肠激素、Cajal间质细胞等与其发病相关。此文就此予以阐述,为STC临床治疗提供依据。     

Plasma cholecystokinin, plasma peptide YY and gallbladder motility in patients with slow transit constipation: effect of intestinal stimulation

BACKGROUND/AIM: Because cholecystokinin and peptide YY are gut hormones with potent effects on gastrointestinal motility, we determined whether abnormalities of cholecystokinin and peptide YY exist in slow transit constipation. METHODS: Plasma concentrations of these hormones before, during and after intraduodenal infusion of a liquid meal in 21 patients with slow transit constipation were compared with the results in 8 healthy controls. RESULTS: Fasting levels of plasma cholecystokinin (3.1+/-0.2 vs. 2.4+/-0.2 pM; p = 0.02) were higher in patients. Basal plasma peptide YY (11.4+/-1.4 vs. 8.9+/-0.7 pM; p = 0.1) tended to be higher in patients. After the meal (60-90 min), incremental cholecystokinin (p<0.05), but not peptide YY, was significantly higher in patients. During intraduodenal infusion of the meal (0-60 min), incremental plasma cholecystokinin (251+/-20 pM.min) and peptide YY (1,146+/-186 pM. min) in patients were almost similar to control values (262+/-22 and 901+/-166 pM. min). Gallbladder volumes before, during and after the meal were not different between the 2 groups. Gastric emptying of a solid meal was delayed in the majority of patients (12 of 18). Abnormalities of plasma cholecystokinin were observed only in patients with delayed gastric emptying. CONCLUSION: Plasma levels of cholecystokinin are elevated in the fasting state and decrease more slowly after stimulation, but maximum release in response to intestinal nutrients is not altered in patients with slow transit constipation. The abnormality seems to be confined to a subgroup of patients with delayed gastric emptying.     

胶质细胞源性神经生长因子与慢传输性便秘

慢传输型便秘(STC)至今病因未明。肠神经系统(ENS)可独立调节肠道功能,其在慢传输型便秘中的改变具有重要意义。胶质细胞源性神经营养因子(GDNF)不仅可促进多种神经元的存活与分化,而且对多种原因造成的神经损伤具有明显的保护作用。此文主要从肠神经系统的功能变化和胶质细胞源性神经营养因子的营养作用这两方面来阐述与功能性便秘之间的相关性。     

慢传输性便秘结肠阿片受体的病理生理改变

目的 为了更加深入地了解慢传输性便秘的发病机理和病理生理改变。方法 应用放射配体结合分析检测了患结肠mu、Kappa阿片受体含量变化。结果 与正常对照组比较,STC患结肠壁肌层ma、Kappa阿片受体含量增加。结论 STC患内源性阿片肽活性增加,肠道运动受抑制,提示阿片受体拮抗剂可能是治疗STC的一个新途径。     

慢传输型便秘外科治疗的主要术式及疗效

近年来,便秘的发病率呈缓慢上升趋势。然而,国际上对于慢传输型便秘的发病原因及发病机理尚未完全认清。虽然经过一段时间的内科保守治疗能够暂时缓解便秘症状,但不能从根本上解决慢传输型便秘的问题。手术可能是最终而有效的治疗慢传输型便秘的方法。现阶段,治疗慢传输型便秘的主要术式有：全结肠切除回直肠吻合术、结肠次全切除盲肠直肠吻合术、结肠旷置术和末端回肠造口术等。本文主要介绍这几种术式及其疗效。     

Proximal gastric motor and sensory function in slow transit constipation.

BACKGROUND: Slow transit constipation may be part of a more generalized gastrointestinal motility disorder. METHODS: Gastric motor and sensory function were evaluated using a barostat in 17 patients with slow transit constipation and in 16 healthy controls. A step-wise isobaric distension procedure was performed, followed by a barostat procedure including a liquid meal. Symptoms were scored using visual analog scales. Plasma levels of gastrointestinal hormones were determined postprandially. RESULTS: Proximal gastric compliance was significantly reduced in the patients. Basal gastric volume did not differ between patients and controls. Postprandial fundus relaxation was significantly reduced in the patients and correlated significantly with daily upper gastrointestinal symptoms. Postprandial secretion of cholecystokinin and gastrin was reduced in the patients. CONCLUSIONS: In patients with slow transit constipation, proximal gastric compliance is reduced and postprandial fundus relaxation is impaired. These findings support the hypothesis that slow transit constipation may be part of a pan-enteric disorder.