{
  "abstract": "Importance\n\nFor patients with slow-transit constipation (STC), total colectomy with ileorectal anastomosis (TC-IRA) remains the standard surgical treatment but is frequently complicated by diarrhea, fecal incontinence, and bowel obstruction. Subtotal colectomy with cecorectal anastomosis (SC-CRA) has emerged as a promising alternative; however, recurrence of constipation remains a critical concern. High-quality evidence comparing these 2 procedures is lacking.Objective\n\nTo compare the 1-year Wexner Constipation Score of patients with STC who underwent SC-CRA vs TC-IRA.Design, setting, and participants\n\nThis multicenter, open-label, noninferiority randomized clinical trial was conducted at 12 tertiary hospitals across 8 provinces in China from April 2022 to April 2025, with 12-month follow-up (final follow-up April 2026). Eligible participants were adults aged 18 years or older with Rome IV-defined functional constipation, fewer than 1 spontaneous bowel movement per week, and long-term laxative dependence, defined as the regular use of osmotic or stimulant laxatives, or prokinetic agents, at least 3 times weekly for 6 months or longer before enrollment. Of 272 adults assessed, 252 were randomized. These data were analyzed from March 2025 to March 2026.Interventions\n\nParticipants were randomly assigned in a 1:1 ratio to undergo either SC-CRA or TC-IRA.Main outcomes and measures\n\nThe primary outcome was the Wexner Constipation Score (WCS) at 12 months, with a prespecified noninferiority margin of 1.32 points. Secondary outcomes included fecal incontinence, morbidity, quality of life, and patient-reported satisfaction.Results\n\nA total of 252 participants (mean age, 49.5 years; 221 female [87.7%] and 31 male [12.3%]) were randomized to undergo SC-CRA (n = 126) or TC-IRA (n = 126). At 12 months, adjusted mean (SD) WCS was 7.01 (3.31) in the SC-CRA group and 6.84 (3.68) in the TC-IRA group (adjusted mean difference, 0.17; 95% CI, -0.93 to 1.27), which fell within the prespecified noninferiority margin of 1.32 (P = .02 for noninferiority). Early postoperative incontinence at 3 months was less frequent in the SC-CRA group than in the TC-IRA group (8.7% vs 21.4%; risk difference, -12.7%; 95% CI, -21.4% to -4.0%; P = .01). Perioperative morbidity did not differ significantly between groups (10.3% vs 12.7%; risk difference, -2.4%; 95% CI, -10.3% to 5.5%; P = .41), and quality-of-life scores at 12 months were comparable. However, patient-reported satisfaction at 12 months favored the TC-IRA group (97.5% vs 95.8%; P = .03).Conclusions and relevance\n\nIn this randomized clinical trial among patients with refractory STC, SC-CRA was noninferior to TC-IRA with respect to the WCS at 12 months, but patient-reported satisfaction at 1 year was higher in the TC-IRA group. Longer-term follow-up is needed.Trial registration\n\nClinicalTrials.gov Identifier: NCT05352074.",
  "abstract_shown": true,
  "affiliations": [
    "Department of General Surgery, Colorectal Division, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China.",
    "Department of Anorectal Surgery, Zhejiang Provincial People's Hospital, Zhejiang, China.",
    "Department of Gastrointestinal Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.",
    "Chengdu Anorectal Hospital, Chengdu, China.",
    "Research Institute of General Surgery, General Hospital of the Eastern Theater Command of the PLA, Nanjing, China.",
    "Department of Colorectum, the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China.",
    "Department of General Surgery, Shanghai Pudong New Area People's Hospital, Shanghai, China.",
    "Department of General Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China.",
    "Department of General Surgery, Qingdao Municipal Hospital, Shandong, China.",
    "Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.",
    "Department of General Surgery, The General Hospital of Western Theater Command, Chengdu, China.",
    "Department of General Surgery, The Second People's Hospital of Yibin, Sichuan, China.",
    "Chongqing Municipal Health Commission Key Laboratory of Intelligent Clinical Nutrition and Transformation, Chongqing, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 23,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Man Guo"
    },
    {
      "affs": [
        0
      ],
      "name": "Fan Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Fan Bu"
    },
    {
      "affs": [
        2
      ],
      "name": "Zhe Cui"
    },
    {
      "affs": [
        3
      ],
      "name": "Haibo Lan"
    },
    {
      "affs": [
        4
      ],
      "name": "Ling Ni"
    },
    {
      "affs": [
        5
      ],
      "name": "Feng Gao"
    },
    {
      "affs": [
        6
      ],
      "name": "Yongbing Wang"
    },
    {
      "affs": [
        7
      ],
      "name": "Jianping Zhou"
    },
    {
      "affs": [
        8
      ],
      "name": "Tao Fu"
    },
    {
      "affs": [
        9
      ],
      "name": "Weicheng Liu"
    },
    {
      "affs": [
        2
      ],
      "name": "Dongbo Xu"
    },
    {
      "affs": [
        3
      ],
      "name": "Xin Liu"
    },
    {
      "affs": [
        5
      ],
      "name": "Hua Gao"
    },
    {
      "affs": [
        0
      ],
      "name": "Bin Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Li Wang"
    },
    {
      "affs": [
        10
      ],
      "name": "Lin Zhang"
    },
    {
      "affs": [
        11
      ],
      "name": "Miao Wu"
    },
    {
      "affs": [
        9
      ],
      "name": "Congqing Jiang"
    },
    {
      "affs": [
        4
      ],
      "name": "Jun Jiang"
    },
    {
      "affs": [
        1
      ],
      "name": "Wenjing Gong"
    },
    {
      "affs": [
        0,
        12
      ],
      "name": "Weidong Tong"
    },
    {
      "name": "STOPS Study Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5qdyvxzct9c0q.bib",
  "cited_by": 0,
  "doi": "10.1001/jamasurg.2026.4932",
  "fulltext_url": "https://europepmc.org/articles/PMC13688208",
  "id": "5qdyvxzct9c0q",
  "issns": [
    "2168-6254",
    "2168-6262"
  ],
  "landing_url": "https://europepmc.org/article/MED/42905730",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2715|Gastrointestinal motility and disorders"
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  "openalex": "W7223107544",
  "pdf_url": null,
  "pmcid": "PMC13688208",
  "pmid": "42905730",
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5qdyvxzct9c0q.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:53Z",
      "native_id": "MED:42905730",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42905730"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2715|Gastrointestinal motility and disorders",
      "subfield": "general"
    }
  ],
  "title": "Subtotal Colectomy vs Total Colectomy for Slow-Transit Constipation: 1-Year Outcomes of the STOPS Randomized Clinical Trial.",
  "title_text": "Subtotal Colectomy vs Total Colectomy for Slow-Transit Constipation: 1-Year Outcomes of the STOPS Randomized Clinical Trial.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:53Z",
  "url": "https://research.draconitic.com/paper/5qdyvxzct9c0q",
  "venue": "JAMA surgery",
  "versions": []
}