For normal people, normal bowel movements, but for some specific groups of people it is particularly difficult, with the continuous development of economic and social and biological pressure, the incidence of constipation is increasing year by year; although many people think that constipation is not a disease, but it can sometimes “kill”, we introduce to you a Below we introduce you to a type of constipation that can be “life-threatening”: intractable constipation. Intractable constipation refers to a type of disease that cannot be cured by medication and must be cured by surgery. Li Yuanxin, general surgery department of the 309th PLA Hospital, is now going to explain and popularize the clinical manifestations, diagnosis and treatment of intractable constipation and the precautions required in the process of medical treatment, in order to facilitate the majority of patients with intractable constipation to seek medical treatment. I. Definition of intractable constipation: the essence of intractable constipation due to congenital colon and rectal anatomical structure variation and gradually produce defecation difficulties at different ages of a class of diseases, not functional but obvious organic changes in the colon and rectal lesions. Because of the different causes of its pathogenesis are divided into: (1) slow transmission type constipation of the colon, or slow movement type constipation, mostly related to part of the colon segment tortuous, redundant and coiled deformity, congenital or acquired reduction or absence of intestinal wall ganglion cells; (2) functional outlet obstruction type constipation, mostly caused by the anatomical structure of the anus, rectum, resulting in the loss of coordination of the internal and external rectal sphincter and defecation power disorders, such as pelvic floor loss (3) mixed constipation, there are both colonic transmission disorder and outlet obstruction, a large number of case studies found that the proportion of mixed type of long-term constipation can reach more than 99%, which is due to two factors of colonic transmission disorder and outlet obstruction as a result of each other, easy to form a vicious circle. Second, the diagnostic criteria: persistent constipation is non-surgical treatment can not be effective, and drug treatment can not cure a class of diseases. Its diagnosis mainly relies on the Rome III criteria: 1. 2 or more of the following must be met: a . Stressful bowel movements (at least 1 in 4 bowel movements); b. Lumpy or hard bowel movements (at least 1 in 4 bowel movements); c. A feeling of incomplete defecation (at least 1 in 4 bowel movements); d . Anorectal obstruction and/or blockage (at least 1 in 4 bowel movements); e . Need for manual manipulation (e.g., finger-assisted defecation, pelvic floor support for defecation) to facilitate defecation (at least 1 out of every 4 defecations): f . Defecation less than 3 times per week. 2. little to no loose stools without laxatives. 3. Insufficient conditions for the diagnosis of irritable bowel syndrome. The above symptoms have been present for at least 6 months, and the above criteria have been met for the last 3 months. Clinical treatment of intractable constipation Ordinary constipation can be relieved by lifestyle modification, improvement of diet structure and proper and appropriate exercise, medication (including oral gastrointestinal stimulants and laxatives), biofeedback therapy and cognitive therapy, while intractable constipation is ineffective for the above treatments and must be solved by surgery. Currently, the main surgical approach is to remove the dysfunctional colon and reconstruct the bowel. Currently, total colectomy, ileorectal anastomosis and subtotal colectomy, lateral anastomosis of the posterior wall of the ascending colon and rectum (Jinling’s procedure) are commonly used. Current case-control studies in large samples have shown that patients with recalcitrant constipation who underwent jinling had better bowel frequency, incidence of diarrhea, procedural satisfaction, gastrointestinal quality of life score, Wexner constipation score, and recovery progress than those who underwent conventional total colectomy. Compared with traditional open surgery, the time to start eating, the number of days in hospital and the overall complication rate after laparoscopic Jinling surgery are significantly lower, and the patient’s pain is significantly reduced; the efficacy is comparable to that of traditional open surgery. Laparoscopic Jinling is an extremely difficult laparoscopic surgical approach. Laparoscopic subtotal colectomy involves a wide area, a large span, and a large number of vessels that need to be ligated from the root. The surgical operation includes all four quadrants of the abdomen, which is equivalent to completing laparoscopic radical rectal cancer surgery, laparoscopic radical left hemicolectomy and laparoscopic radical right hemicolectomy at the same time, and also requires a unique skill of lateral anastomosis of the posterior wall of the ascending colon – rectum, which is a difficult operation. The Li Yuanxin Surgical Group of the 309th Hospital of the People’s Liberation Army is one of only a few units in China that can complete the Jinling operation under complete laparoscopy. Fourth, consultation guidance: If you meet the above diagnostic criteria for intractable constipation, in order to save your time and not waste valuable medical opportunities, please do the following: 1. Please organize the patient’s disease course and treatment according to the following contents, so as to quickly, accurately and comprehensively demonstrate the development of the disease. For example: (1) how long have you had dry stools and dyspareunia in the past (e.g., how many years since the onset of the disease), how many times do you have a bowel movement, how often do you have strained or incomplete bowel movements or dry stools or dyspareunia; (2) have you taken oral laxatives, gastric motility drugs and biofeedback therapy, the type and duration of oral drugs, and how effective is the treatment? (2) whether the symptoms of constipation are progressively worsening, whether there is a history of intestinal obstruction; (3) whether biofeedback treatment has been done, and what is the effect: (4) whether relevant treatment has been done in outside hospitals, if surgical treatment has been done, please bring the operation records. Please complete the following tests at a local general hospital or specialized anorectal hospital to shorten your and your family’s hospital stay in Beijing, and prepare relevant test reports and radiological imaging films: (1) abdominopelvic enhanced CT and e-colonoscopy to exclude abdominal and colorectal occupying lesions; (2) barium enema after careful bowel preparation to clarify the anatomical and pathological basis of colonic redundancy; (3) barium enema after careful bowel preparation to clarify the anatomical basis of colonic redundancy; (4) barium enema after careful bowel preparation to clarify the anatomical basis of colonic redundancy. (3), slow transmission test of the colon to clarify the presence of slow transmission pathology of the colon; (4), fecal imaging to clarify the anatomical pathology of functional outlet constipation due to pelvic floor dysfunction. (For details, please refer to the article “Minimally invasive laparoscopic surgery (Jinling surgery) for chronic intractable constipation” in the website) Dr. Li Yuanxin, chief physician of the general surgery department of the 309th Hospital of the People’s Liberation Army, studied and worked in the Institute of General Surgery of Nanjing General Hospital of Nanjing Military Region for nearly 20 years under the guidance of academician Li. Under the guidance of Academician Li, he has treated a large number of complicated gastrointestinal surgery patients from all over the country, and formed unique techniques of separation of severe abdominal adhesions, intestinal fistula abdominal infection drainage and digestive tract reconstruction techniques, minimally invasive laparoscopic surgery techniques, small intestine transplantation and abdominal multi-organ cluster transplantation techniques, and surgical nutritional support, which are distinctive and extremely difficult techniques. Small bowel transplantation and abdominal multi-organ cluster transplantation are the pinnacle of gastrointestinal surgery technology. Prof. Yuanxin Li is a famous expert in small bowel transplantation in China and has authored the guidelines and operation specifications for small bowel transplantation in China. In 2012, as the leader of the discipline, he entered the second ward of general surgery of the 309th Hospital of the PLA and formed the main technical characteristics of complex intestinal obstruction, intestinal fistula and radiation enteritis, and minimized conventional surgery, and completed dozens of cases of total laparoscopic colon and sub-total colon, lateral anastomosis of the posterior wall of ascending colon and rectum (Jinling operation), and the abdominal auxiliary surgical incision is only 4-5 cm to remove the abdominal intestinal obstruction that has been completely removed under laparoscopy. The postoperative follow-up of the patient suggested good results. With the advancement of our technology, we can omit the 4-5 cm abdominal adjuvant incision used to remove the subtotal resected colon specimen for some of the younger and thinner patients, and complete the abdominal class-NOTES surgery without adjuvant incision. A class-NOTES procedure is the routine use of minimally invasive laparoscopic instruments combined with a unique GI reconstruction approach to remove the resected colon specimen through the natural lumen (usually the patient’s rectum), leaving only a few poke and puncture scars on the abdominal wall without an adjuvant incision. This type of surgery maximizes the advantages and concept of minimally invasive surgery and is the direction of colorectal laparoscopic surgery. You can pay attention to the official website of 309 Hospital and the doctor’s webpage to make an appointment and get the information of clinic closure and clinic time change in advance; in order to get the latest consultation information, more timely treatment and more professional preoperative and postoperative health guidance, you can join the personal doctor’s website of Director Li Yuanxin:. We wish all our patients a speedy recovery! Second Ward of General Surgery, PLA No. 309 Hospital