Surgery for constipation: systematic review and practice recommendations

• Published in: Colorectal disease Vol. 19; no. S3; pp. 37 - 48
• Main Authors: Grossi, U., Knowles, C. H., Mason, J., Lacy‐Colson, J., Brown, S. R., Campbell, Kenneth, Chapman, Mark, Clarke, Andrew, Cruickshank, Neil, Dixon, Anthony, Emmett, Christopher, Hooper, Richard, Horrocks, Emma, Lindsey, Ian, Mercer‐Jones, Mark, Miller, Andrew, Pares, David, Pilkington, Sophie, Smart, Neil, Stevens, Natasha, Tincello, Douglas, Telford, Karen, Vollebregt, Paul, Williams, Andrew, Yiannakou, Yan
• Format: Journal Article
• Language: English
• Published: Chichester Wiley Subscription Services, Inc 01.09.2017
• Subjects: chronic constipation; Clinical trials; Complications; Constipation; Decision making; Intussusception; laparoscopic resection rectopexy (LRR); laparoscopic ventral mesh rectopexy (LVMR); Laparoscopy; Morbidity; open rectopexy (OR); Rectopexy; Rectum; robotic ventral mesh rectopexy (RVMR); Surgery
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13773

Aim To assess the outcomes of rectal suspension procedures (forms of rectopexy) in adults with chronic constipation. Method Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence‐Based Medicine (2009) level. Results Eighteen articles were identified, providing data on outcomes in 1238 patients. All studies reported only on laparoscopic approaches. Length of procedures ranged between 1.5 to 3.5 h, and length of stay between 4 to 5 days. Data on harms were inconsistently reported and heterogeneous, making estimates of harm tentative and imprecise. Morbidity rates ranged between 5–15%, with mesh complications accounting for 0.5% of patients overall. No mortality was reported after any procedures in a total of 1044 patients. Although inconsistently reported, good or satisfactory outcome occurred in 83% (74–91%) of patients; 86% (20–97%) of patients reported improvements in constipation after laparoscopic ventral mesh rectopexy (LVMR). About 2–7% of patients developed anatomical recurrence. Patient selection was inconsistently documented. As most common indication, high grade rectal intussusception was corrected in 80–100% of cases after robotic or LVMR. Healing of prolapse‐associated solitary rectal ulcer syndrome occurred in around 80% of patients after LVMR. Conclusion Evidence supporting rectal suspension procedures is currently derived from poor quality studies. Methodologically robust trials are needed to inform future clinical decision making.