BACKGROUND: Surgery is indicated for chronic constipation refractory to conservative therapy. The treatment of combined slow-transit constipation and obstructive defecation is controversial. OBJECTIVE: The aim of the study is to describe the Jinling procedure and examine safety, effectiveness, and quality of life over 4 years of follow-up. DESIGN: The study is a retrospective review of prospectively gathered data in a patient registry database. SETTINGS: This investigation was conducted at a tertiary-care gastroenterology surgical center in China. PATIENTS: The study included 117 consecutive patients with slow-transit constipation combined with obstructive defecation treated between January 2005 and December 2007. INTERVENTION: The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis to solve the coexistence of obstructive defecation and slow-transit constipation in one operation. MAIN OUTCOME MEASURES: We measured morbidity and mortality rates, Wexner constipation scores, and Gastrointestinal Quality of Life Index at baseline and after 1, 6, 12, 24, 36 and 48 months of follow-up. RESULTS: A total of 117 patients underwent the Jinling procedure, which was laparoscopically assisted in 56 patients (47.9%) and an open procedure in 61 patients (52.1%). Of the total, 72 patients (61.5%) had undergone previous surgical intervention without improvement. A total of 28 complications and adverse events were reported in 117 procedures, giving an overall morbidity rate of 23.9%; 23 patients (19.7%) had 1 or more events. Most complications were managed conservatively. A significant reduction in Wexner constipation score was observed from baseline (mean, 21.9) to 1 month (mean, 9.8), and the reduction was maintained at 48 months (mean 5.1; p < 0.001). Compared with baseline, significant overall improvements were also seen in gastrointestinal quality of life at 12, 24, and 48 months of follow-up (p < 0.01). LIMITATIONS: This study did not include a comparison group. CONCLUSIONS: Our clinical practice demonstrates that Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after 4-year follow up.
BACKGROUND: Surgery is indicated for chronic constipation refractory to conservative therapy. The treatment of combined slow-transit constipation and obstructive defecation is controversial. OBJECTIVE: The aim of the study is to describe the Jinling procedure and examine safety, effectiveness, and quality of life over 4 years of follow-up. DESIGN: The study is a retrospective review of prospectively gathered data in a patient registry database. SETTINGS: This investigation was conducted at a tertiary-care gastroenterology surgical center in China. PATIENTS: The study included 117 consecutive patients with slow-transit constipation combined with obstructive defecation treated between January 2005 and December 2007. INTERVENTION: The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis to solve the coexistence of obstructive defecation and slow-transit constipation in one operation. MAIN OUTCOME MEASURES: We measured morbidity and mortality rates, Wexner constipation scores, and Gastrointestinal Quality of Life Index at baseline and after 1, 6, 12, 24, 36 and 48 months of follow-up. RESULTS: A total of 117 patients underwent the Jinling procedure, which was laparoscopically assisted in 56 patients (47.9%) and an open procedure in 61 patients (52.1%). Of the total, 72 patients (61.5%) had undergone previous surgical intervention without improvement. A total of 28 complications and adverse events were reported in 117 procedures, giving an overall morbidity rate of 23.9%; 23 patients (19.7%) had 1 or more events. Most complications were managed conservatively. A significant reduction in Wexner constipation score was observed from baseline (mean, 21.9) to 1 month (mean, 9.8), and the reduction was maintained at 48 months (mean 5.1; p < 0.001). Compared with baseline, significant overall improvements were also seen in gastrointestinal quality of life at 12, 24, and 48 months of follow-up (p < 0.01). LIMITATIONS: This study did not include a comparison group. CONCLUSIONS: Our clinical practice demonstrates that Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after 4-year follow up.