Laparoscopic-assisted natural orifice specimen extraction subtotal colectomy for redundant colon: a retrospective parallel-cohort comparative study with reduced surgical site infections and accelerated recovery.

BACKGROUND: Redundant colon is one of the anatomical causes of slow transit constipation (STC). When conservative management fails, surgical intervention with subtotal colectomy is indicated. This study aimed to compare the perioperative outcomes of laparoscopy-assisted natural orifice specimen extraction (LA-NOSE) subtotal colectomy with conventional laparoscopy-assisted subtotal colectomy for redundant colon. METHODS: A retrospective analysis was conducted on 34 patients with redundant colon who underwent laparoscopy-assisted subtotal colectomy with cecorectal anastomosis at the Affiliated Hospital of Chengdu University between January 2009 and January 2026. Of these, 16 patients underwent LA-NOSE and 18 underwent conventional surgery with a mini-laparotomy for specimen extraction. Categorical perioperative outcomes were compared using Fisher's exact test. RESULTS: Baseline characteristics were comparable between the two groups. The LA-NOSE group showed certain advantages in postoperative recovery: sitting up within 24 h (87.5% vs. 38.9%, p = 0.005), getting out of bed within 2 days (93.8% vs. 55.6%, p = 0.019), ambulation within 3 days (100% vs. 72.2%, p = 0.046), return of gastrointestinal function within 2 days (62.5% vs. 27.8%, p = 0.045), liquid diet tolerance within 3 days (87.5% vs. 44.4%, p = 0.013), and earlier suture removal on days 6-7 (100% vs. 0%, p < 0.001). The incidence of surgical site infection (SSI) was significantly lower in the LA-NOSE group (0% vs. 27.8%, p = 0.046). Operative time, estimated blood loss, and the incidence of intestinal obstruction, anastomotic leakage, and intra-abdominal infection showed no significant differences between the groups. CONCLUSION: LA-NOSE subtotal colectomy is a safe and feasible minimally invasive option for redundant colon, offering accelerated postoperative recovery, reduced SSI, and superior cosmetic outcomes without compromising safety. This technique adheres to the principles of Enhanced Recovery After Surgery (ERAS) and offers an alternative treatment option for transnatural orifice specimen extraction in benign colonic diseases.