Symmetrical single-port +2 around the umbilicus (Tang style) laparoscopic total colectomy for refractory constipation

Background and objective: This study aimed to evaluate the efficacy of the symmetrical single-port + 2 around the umbilicus laparoscopic (Tang style) total colectomy in the treatment of refractory constipation.. Methods From June 2023 to December 2024, 40 patients with refractory constipation underwent the symmetrical single-port + 2 around the umbilicus laparoscopic (Tang style) total colectomy. Preoperative assessments included modified colonic transit tests, defecography, physical examinations, and multiple standardized scales. Postoperative efficacy was evaluated via follow-up questionnaires at 3 and 6 months. Results At the 3-month follow-up, the mean weekly spontaneous bowel movements significantly increased from 2.68 ± 2.25 to 21.30 ± 7.24 (P < 0.01). Significant improvements were also observed in the PAC-QOL quality of life scale, Wexner constipation score, PHQ-9 depression scale, and GAD-7 anxiety scale (P < 0.01). At the 6-month follow-up, therapeutic effects remained stable, with a mean weekly spontaneous bowel movement frequency of 18.55 ± 5.48, along with sustained improvements in quality of life and psychological scores. No surgery-related mortality occurred. Three cases (7.5%) of minor complications or adverse events were reported, most of which resolved with conservative management. Patient satisfaction was 87.5% at 3 months and further improved to 92.5% at 6 months. Conclusions The symmetrical single-port + 2 around the umbilicus laparoscopic (Tang style) total colectomy is a safe and effective surgical approach for chronic refractory constipation, demonstrating significant and sustained improvements in bowel function, quality of life, and psychological well-being with minimal complications.