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Surgery for constipation : systematic review and practice recommendations : Results I: Colonic resection
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Pelvic floor Society , National Institute for Health Research: Chronic Constipation Treatment Pathway (Including: Knowles, C. H., Grossi, U., Chapman, M. and Mason, James). (2017) Surgery for constipation : systematic review and practice recommendations : Results I: Colonic resection. Colorectal Disease, 19 (S3). pp. 17-36. doi:10.1111/codi.13779 ISSN 1462-8910.
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WRAP-surgery-constipation-systematic-results-colonic-Mason-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1212Kb) | Preview |
Official URL: http://dx.doi.org/10.1111/codi.13779
Abstract
Aim
To assess the outcomes of colectomy in adults with chronic constipation (CC).
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 (SES) with a summative Oxford Centre for Evidence-Based Medicine (2009) level.
Results
Forty articles were identified, providing data on outcomes in 2045 patients. Evidence was derived almost exclusively from observational studies, the majority of which concerned colectomy and ileorectal anastomosis (CIRA) rather than other procedural variations. Average length of stay (LOS) ranged between 7–15 days. Although inconsistent, laparoscopic surgery may be associated with longer mean operating times (210 vs 167 min) and modest decreases in LOS (10–8 days). Complications occurred in approximately 24% of patients. Six (0.4%) procedure-related deaths were observed. Recurrent episodes of small bowel obstruction occurred in about 15% (95%CI: 10–21%) of patients in the long-term, with significant burden of re-hospitalisation and frequent recourse to surgery. Most patients reported a satisfactory or good outcome after colectomy but negative long-term functional outcomes persist in a minority of patients. The influence of resection extent, anastomotic configuration and method of access on complication rates remains uncertain. Available evidence weakly supports selection of patients with an isolated slow-transit phenotype.
Conclusion
Colectomy for CC may benefit some patients but at the cost of substantial short- and long-term morbidity. Current evidence is insufficient to guide patient or procedural selection.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Constipation -- Treatment -- Standards, Surgery, Colectomy | ||||||
Journal or Publication Title: | Colorectal Disease | ||||||
Publisher: | Wiley-Blackwell Publishing, Inc. | ||||||
ISSN: | 1462-8910 | ||||||
Official Date: | 29 September 2017 | ||||||
Dates: |
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Volume: | 19 | ||||||
Number: | S3 | ||||||
Page Range: | pp. 17-36 | ||||||
DOI: | 10.1111/codi.13779 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 3 October 2017 | ||||||
Date of first compliant Open Access: | 3 October 2017 | ||||||
Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||||
Grant number: | RP-PG-0612-20001 |
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