[Single center study of short-term and 10-year efficacy of performing the Jinling procedure on 3 310 patients with refractory mixed constipation].

Abstract

Objective: To evaluate the safety, effectiveness, and long-term efficacy of the Jinling procedure for management of refractory mixed constipation. Methods: We prospectively collected clinical data of patients with refractory mixed constipation treated by the Jinling procedure in the Institute of General Surgery of our hospital from January 2007 to August 2023. Perioperative complications, effectiveness within 1 year of surgery (as assessed by the Wexner constipation score, gastrointestinal quality of life index, frequency of spontaneous defecation, rate of satisfactory defecation, body composition, serological indicators, defecography, anorectal manometry) and 10 years after surgery (as assessed by the Wexner constipation score, patient assessment of constipation symptom, SF-36 quality of life score, and questionnaire concerning satisfaction with defecation). Results: The study cohort comprised 3310 patients of mean age 44±15 years, including 653 men and 2657 women. The duration of constipation was 141±114 months. The 1-month, 3-month, 6-month, and 12-month follow-up rates were 98.07% (3246/3310), 95.11% (3148/3310), 93.38% (3091/3310), and 92.81% (3072/3310), respectively. Overall, 1100 patients had undergone surgery at least 10 years previously, 683 of whom completed the questionnaire, making the 10-year follow-up rate 62.09%. The overall incidence of postoperative complications was 21.99% (728/3310), mortality 0.45% (15/3310), and duration of postoperative hospital stay 12.5±5.4 days. Compared with preoperative values, Wexner scores decreased significantly from 1 to 12 months after surgery, whereas the gastrointestinal quality of life index scores had gradually increased by 3 months after surgery; both changes were statistically significant (both P < 0.001). The frequency of spontaneous defecation increased significantly to > five times/day 1 month after surgery, following which it decreased gradually with time, falling to two to five times/day by 6 months after surgery. All nutritional indicators returned to preoperative levels within 1 year except for that of inorganic salt, which did not change significantly. By 6-12 months after surgery, the proportions of rectocele, mucosal prolapse, internal rectal intussusception, visceral ptosis, perineal descent, pelvic floor spasm, and puborectalis syndrome assessed by defecography were all significantly lower than before surgery (all P < 0.05). By 3 months after surgery, the anal resting pressure, anal maximum systolic pressure, and anorectal depression had all returned to preoperative levels. Twelve months after surgery, the rectoanal inhibition reflex was stronger than that before surgery, whereas anal relaxation was less pronounced than that before surgery; these differences are statistically significant (both P < 0.05). The Wexner scores (7±2 vs. 21±6) and patient assessment of constipation symptoms scores (13±5 vs. 39±5) were significantly lower 10 years after the Jinling procedure than they had been before surgery. The eight dimensions of the SF-36 quality of life scores for physical functioning (90±5 vs. 78±8), role limitations in physical functioning (89±12 vs. 50±24), bodily pain (67±18 vs. 33±22), emotional well-being (63±23 vs. 48±30), vitality (71±11 vs. 31±13), mental health (71±10 vs. 30±10), social functioning (69±17 vs. 26±15) and general health (79±9 vs. 35±12) had all improved significantly (all P < 0.001). The total rates of satisfaction with defecation were 95.02% (2919/3072) and 87.56% (598/683) 1 year and 10 years after surgery, respectively. Conclusion: The Jinling procedure is a safe and effective means of treating refractory mixed constipation, achieving improvement in long-term defecation function and gastrointestinal quality of life.