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Surgery for constipation : systematic review and practice recommendations : Results II: Hitching procedures for the rectum (rectal suspension)
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The Pelvic floor Society, National Institute for Health Research: Chronic Constipation Treatment Pathway (Including: Grossi, U., Knowles, C. H., Mason, James, Lacy-Colson, J. and Brown, S. R.). (2017) Surgery for constipation : systematic review and practice recommendations : Results II: Hitching procedures for the rectum (rectal suspension). Colorectal Disease, 19 (S3). pp. 37-48. doi:10.1111/codi.13773
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Official URL: http://dx.doi.org/10.1111/codi.13773
Abstract
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.
| 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, Rectum -- Surgery | ||||||
| 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. 37-48 | ||||||
| DOI: | 10.1111/codi.13773 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||||
| Grant number: | RP-PG-0612-20001 |
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