Pay attention to the standardized diagnosis and treatment of refractory constipation        LI Ning. Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Affiliated Jinling Hospital of Nanjing University School of Medicine, Nanjing 210002,China
Abstract    The primary factors impacting outcomes of patients with refractory constipation include the non-standardization of diagnosis, operative and non-operative therapy. The treatment of refractory constipation should be based on systematic examines and evaluation. After grading and typing the patients according to the cause of the disease, we could then determine the therapeutic regimen and principle. Non-operative therapy is the first choice for refractory constipation, we should use an individual systematic therapy which contains dietary therapy, psychological treatment, biofeedback therapy, optimal stepped medication and regulation of biological metabolism instead of the traditional medicine mainly therapy. Operative therapy is the last choice after the non-operative therapy has failed, and then most of the patients have developed to refractory mixed constipation. The surgery procedure specifically designed for isolated slow-transit constipation or obstructive defecation cannot achieve ideal effect. To treat severe refractory constipation in patients with combined slow-transit constipation and obstructive defecation, a new surgical procedure (named “Jinling procedure” in our hospital) was developed. The Jinling procedure combines subtotal colectomy and side-to-side cecorectal anastomosis, aiming to solve the coexistence of obstructive defecation and slow-transit constipation in one operation. Initial and long term results have been promising. With the development of laparoscopy and the further rationalization of surgical treatment for constipation, the minimally invasive surgery would play an important role in treating constipation.