Laparoscopic-assisted subtotal colectomy cecal-rectal anastomosis for redundant colon-associated slow-transit constipation: a single-center retrospective case series with long-term follow-up

Background: Redundant colon represents a common anatomical substrate underlying slow transit constipation (STC). Although total colectomy with ileorectal anastomosis (TAC-IRA) reliably alleviates constipation, it is frequently associated with debilitating postoperative diarrhea. Subtotal colectomy cecal-rectal anastomosis (SCC-CRA) has emerged as a bowel-preserving alternative hypothesized to reduce diarrheal complications. This study aimed to evaluate the short- and long-term efficacy of laparoscopic-assisted SCC-CRA in patients with redundant colon. Methods: A retrospective analysis was conducted on 34 patients with redundant colon who underwent laparoscopic-assisted SCC-CRA between January 2016 and June 2025 at Chengdu University Affiliated Hospital. Clinical outcomes, including weekly bowel frequency, straining symptoms, and stool consistency (Bristol Stool Form Scale), were assessed preoperatively and at 8 months postoperatively. Long-term follow-up was performed at 2, 4, and 6 years after surgery. Results: All 34 patients (9 male, 25 female) successfully underwent the procedure without conversion to laparotomy. At 8 months postoperatively, all patients achieved more than three bowel movements per week (mean, 1-2 times/day), compared with 32 patients (94.1% [95% CI: 76-98%]) who had fewer than three movements per week preoperatively. Straining during defecation resolved completely, decreasing from 32 patients (94.1% [95% CI: 76-98%]) to none, and hard or lumpy stools (Bristol type 1-2) were eliminated, decreasing from 31 patients (91.2% [95% CI: 76-98%]) to none. Patients have a low reported incidence of diarrhea. Bowel frequency gradually normalized over time, declining from a peak of 4.8 ± 1.5 times/day at 3 months to 3.7 ± 1.3 times/day at 6 months. Long-term follow-up was available for 28 out of 34 patients (82.4%) at 2 years, 22 out of 34 patients (64.7%) at 4 years, and 15 out of 34 patients (44.1%) at 6 years, no symptomatic recurrence among available follow-ups. Conclusion: Laparoscopic-assisted subtotal colectomy cecal-rectal anastomosis is feasible with acceptable short-term outcomes as a surgical option for patients with redundant colon, providing significant and durable relief of constipation symptoms with a low risk of postoperative diarrhea. Both short-term and long-term outcomes are favorable.