STOPS Trial: Total vs Subtotal Colectomy for Slow Transit Constipation

NCT ID: NCT05352074

Last Updated: 2025-03-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

252 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-27

Study Completion Date

2028-12-31

Brief Summary

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Total colectomy with ileorectal anastomosis is a traditional surgical option for slow transit constipation (STC). Subtotal colectomy with caecorectal anastomosis have been reported to be a potential alternative approach. Thus, the optimal surgical option for STC is controversial.

Detailed Description

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Constipation, a prevalent gastrointestinal disorder, affects 10%-15% of adults in the United States and approximately 8.2% of China's general population. Slow transit constipation (STC), accounting for 15%-42% of constipation cases, is characterized by impaired colonic motility. For patients refractory to conservative therapies who experience chronic, intractable symptoms and diminished quality of life (QoL), surgical intervention becomes the last-resort treatment. The primary surgical approach for STC has historically been total colectomy with ileorectal anastomosis (TC-IRA). Over the past two decades, however, subtotal colectomy with cecorectal anastomosis (SC-CRA) has garnered growing interest within the surgical community due to its potential to mitigate postoperative diarrhea. Despite this benefit, SC-CRA raises concerns about an elevated risk of recurrent constipation. The debate regarding the superiority of these approaches remains unresolved. This study aims to address this controversy through a comparative analysis of TC-IRA and SC-CRA, evaluating their therapeutic efficacy and safety profiles in refractory STC.

Conditions

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Slow Transit Constipation Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Total colectomy with ileorectal anastomosis

Total colectomy with ileorectal anastomosis (TC-IRA) serves as the standard surgical treatment for slow transit constipation.

Group Type ACTIVE_COMPARATOR

Total colectomy with ileorectal anastomosis

Intervention Type PROCEDURE

Following complete colonic mobilization without preservation of the ileocolic vascular pedicle, the surgical specimen was extracted by extending the right lower quadrant trocar incision to approximately 4-5 cm. A resection of ileum, 2-3 cm proximal to the ileocecal junction, will be conducted by stapler. The anvil of a 29-mm circular stapler was inserted into the proximal ileal lumen and repositioned intra-abdominally. Ileorectal anastomosis was performed by transanal insertion of the circular stapler, aiming to achieve a tension-free, contamination-minimized reconstruction. Finally, a closed suction drain was placed in the rectouterine pouch (Douglas pouch), and all abdominal incisions were closed in layers.

Subtotal colectomy with cecal-rectal anastomosis

Subtotal colectomy with cecorectal anastomosis (SC-CRA) is selectively employed for slow transit constipation.

Group Type EXPERIMENTAL

Subtotal colectomy with cecal-rectal anastomosis

Intervention Type PROCEDURE

Following complete colonic mobilization with preservation of the ileocolic vascular pedicle and its branches, the surgical specimen was extracted by extending the right lower quadrant trocar incision to 4-5 cm. After insertion of the anvil from a 29-mm circular stapler through the ascending colon resection margin, a resection about 3 cm distal to the ileocecal junction will be conducted. The cecum was then positioned in the pelvis without rotational torsion, and an antiperistaltic cecorectal anastomosis was created between cecal fundus (after appendectomy) and the rectal stump. The anastomosis was performed via transanal insertion of the circular stapler to ensure tension-free, contamination-controlled reconstruction. Finally, a closed suction drain was placed in the rectouterine pouch (Douglas pouch), and all abdominal incisions were closed in a layered fashion.

Interventions

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Total colectomy with ileorectal anastomosis

Following complete colonic mobilization without preservation of the ileocolic vascular pedicle, the surgical specimen was extracted by extending the right lower quadrant trocar incision to approximately 4-5 cm. A resection of ileum, 2-3 cm proximal to the ileocecal junction, will be conducted by stapler. The anvil of a 29-mm circular stapler was inserted into the proximal ileal lumen and repositioned intra-abdominally. Ileorectal anastomosis was performed by transanal insertion of the circular stapler, aiming to achieve a tension-free, contamination-minimized reconstruction. Finally, a closed suction drain was placed in the rectouterine pouch (Douglas pouch), and all abdominal incisions were closed in layers.

Intervention Type PROCEDURE

Subtotal colectomy with cecal-rectal anastomosis

Following complete colonic mobilization with preservation of the ileocolic vascular pedicle and its branches, the surgical specimen was extracted by extending the right lower quadrant trocar incision to 4-5 cm. After insertion of the anvil from a 29-mm circular stapler through the ascending colon resection margin, a resection about 3 cm distal to the ileocecal junction will be conducted. The cecum was then positioned in the pelvis without rotational torsion, and an antiperistaltic cecorectal anastomosis was created between cecal fundus (after appendectomy) and the rectal stump. The anastomosis was performed via transanal insertion of the circular stapler to ensure tension-free, contamination-controlled reconstruction. Finally, a closed suction drain was placed in the rectouterine pouch (Douglas pouch), and all abdominal incisions were closed in a layered fashion.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Patients (≥18 years of age) of either sex
2. Patients with conditions in agreement with the Roman IV criteria of functional constipation
3. Patients have less than one complete spontaneous bowel movement per week
4. Patients rely on laxatives to assist defecation for a long time
5. More than 20% the radio-paque markers localized in the colon after 72 hours based on colonic transit studies
6. Patients were refractory to conservative treatment for more than 1 year
7. Patients with a strong desire for surgery

Exclusion Criteria

1. Pregnant or breast-feeding women
2. Patients with megacolon, megarectum,severe spastic constipation, severe rectocele, rectal prolapse (Oxford Grade IV or above)
3. Patients with colorectal neoplasms
4. Patients with small intestinal slow transit
5. Patients with constipation-predominant irritable bowel syndrome
6. Patients with inflammatory bowel disease
7. Patients with ileostomy
8. Patients with severe psychiatric disease
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Third Military Medical University

OTHER

Sponsor Role lead

Responsible Party

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Weidong Tong

Director

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Weidong Tong, MD

Role: STUDY_DIRECTOR

Army Medical Center (Daping Hospital)

Locations

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Army Medical Center (Daping Hospital)

Yuzhong, Chongqing Municipality, China

Site Status RECRUITING

No. 940 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army

Lanzhou, Gansu, China

Site Status RECRUITING

The People's Hospital of Guangxi Zhuang Autonomous Region

Nanning, Guangxi, China

Site Status WITHDRAWN

The First Affiliated Hospital of Harbin Medical University

Harbin, Heilongjiang, China

Site Status WITHDRAWN

Renmin Hospital of Wuhan University

Wuhan, Hubei, China

Site Status RECRUITING

Zhongnan Hospital of Wuhan University

Wuhan, Hubei, China

Site Status RECRUITING

General Hospital of the Eastern Theater Cammand of the PLA

Nanjing, Jiangsu, China

Site Status RECRUITING

The First Hospital of China Medical University

Shengyang, Liaoning, China

Site Status RECRUITING

Qingdao Municipal Hospital

Qingdao, Shandong, China

Site Status RECRUITING

Renji Hospital, Shanghai Jiaotong University

Pudong, Shanghai Municipality, China

Site Status RECRUITING

Shanghai Pudong New Area People's Hospital

Pudong, Shanghai Municipality, China

Site Status RECRUITING

Xijing Hospital

Xi’an, Shanxi, China

Site Status RECRUITING

Chengdu Analrectal Hospital

Chengdu, Sichuan, China

Site Status RECRUITING

The General Hospital of Western Theater Command

Chengdu, Sichuan, China

Site Status RECRUITING

The Second People's Hospital of Yibin

Yibin, Sichuan, China

Site Status RECRUITING

Zhejiang Provincial People's Hospital

Hangzhou, Zhejiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Man Guo, MS

Role: CONTACT

15672662968

Facility Contacts

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Weidong Tong, MD

Role: primary

02368729356

Feng Gao, MD

Role: primary

Tao Fu, MD

Role: primary

Congqing Jiang, MD

Role: primary

Jun Jiang, MD

Role: primary

13809021165

Jianping Zhou, MD

Role: primary

13840509519

Tao Fu, MD

Role: primary

13720120190

Zhe Cui, MD

Role: primary

Yongbing Wang, MD

Role: primary

Jianyong Zheng, MD

Role: primary

Haibo Lan, MD

Role: primary

15902820940

Lin Zhang, MD

Role: primary

Miao Wu, MD

Role: primary

13990905852

Wenjing Gong, MD

Role: primary

References

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Macha MR. The feasibility of laparoscopic subtotal colectomy with cecorectal anastomosis in community practice for slow transit constipation. Am J Surg. 2019 May;217(5):974-978. doi: 10.1016/j.amjsurg.2019.03.018. Epub 2019 Mar 26.

Reference Type RESULT
PMID: 30948148 (View on PubMed)

Wei D, Cai J, Yang Y, Zhao T, Zhang H, Zhang C, Zhang Y, Zhang J, Cai F. A prospective comparison of short term results and functional recovery after laparoscopic subtotal colectomy and antiperistaltic cecorectal anastomosis with short colonic reservoir vs. long colonic reservoir. BMC Gastroenterol. 2015 Mar 18;15:30. doi: 10.1186/s12876-015-0257-7.

Reference Type RESULT
PMID: 25887580 (View on PubMed)

Perivoliotis K, Baloyiannis I, Tzovaras G. Cecorectal (CRA) versus ileorectal (IRA) anastomosis after colectomy for slow transit constipation (STC): a meta-analysis. Int J Colorectal Dis. 2022 Mar;37(3):531-539. doi: 10.1007/s00384-022-04093-y. Epub 2022 Jan 12.

Reference Type RESULT
PMID: 35020001 (View on PubMed)

Knowles CH, Grossi U, Horrocks EJ, Pares D, Vollebregt PF, Chapman M, Brown S, Mercer-Jones M, Williams AB, Yiannakou Y, Hooper RJ, Stevens N, Mason J; NIHR CapaCiTY working group; Pelvic floor Society and; European Society of Coloproctology. Surgery for constipation: systematic review and practice recommendations: Graded practice and future research recommendations. Colorectal Dis. 2017 Sep;19 Suppl 3:101-113. doi: 10.1111/codi.13775.

Reference Type RESULT
PMID: 28960922 (View on PubMed)

Deng XM, Zhu TY, Wang GJ, Gao BL, Li RX, Wang JT. Laparoscopic total colectomy with ileorectal anastomosis and subtotal colectomy with antiperistaltic cecorectal anastomosis for slow transit constipation. Updates Surg. 2023 Jun;75(4):871-880. doi: 10.1007/s13304-023-01458-y. Epub 2023 Mar 14.

Reference Type RESULT
PMID: 36914915 (View on PubMed)

Tian Y, Guo M, Bu F, Ni L, Liu W, Gao F, Lan H, Cui Z, Fu T, Wang Y, Li F, Xu D, Gao H, Zhang L, Liu X, Huang B, Wang L, Jiang C, Jiang J, Gong W, Tong W. Total colectomy with ileorectal anastomosis versus subtotal colectomy with cecal-rectal anastomosis for slow transit constipation: protocol for a multicenter randomized controlled trial (STOPS trial). Trials. 2025 Oct 10;26(1):402. doi: 10.1186/s13063-025-09049-5.

Reference Type DERIVED
PMID: 41074220 (View on PubMed)

Other Identifiers

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20211114

Identifier Type: -

Identifier Source: org_study_id

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