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Surgery for constipation : systematic review and practice recommendations : Results III: Rectal wall excisional procedures (Rectal Excision)

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The Pelvic floor Society, National Institute for Health Research: Chronic Constipation Treatment Pathway (Including: Mercer-Jones, M., Grossi, U., Pares, D., Vollebregt, P. F., Mason, James and Knowles, C. H.). (2017) Surgery for constipation : systematic review and practice recommendations : Results III: Rectal wall excisional procedures (Rectal Excision). Colorectal Disease, 19 (S3). pp. 49-72. doi:10.1111/codi.13772 ISSN 1462-8910.

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Official URL: http://dx.doi.org/10.1111/codi.13772

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Abstract

Aim

To assess the outcomes of rectal excisional procedures 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

Forty-seven studies were identified, providing data on outcomes in 8340 patients. Average length of procedures was 44 min and length of stay (LOS) was 3 days. There was inadequate evidence to determine variations in procedural duration or LOS by type of procedure. Overall morbidity rate was 16.9% (0–61%), with lower rates observed after Contour Transtar procedure (8.9%). No mortality was reported after any procedures in a total of 5896 patients. Although inconsistently reported, good or satisfactory outcome occurred in 73–80% of patients; a reduction of 53–91% in Longo scoring system for obstructive defecation syndrome (ODS) occurred in about 68–76% of patients. The most common long-term adverse outcome is faecal urgency, typically occurring in up to 10% of patients. Recurrent prolapse occurred in 4.3% of patients. Patients with at least 3 ODS symptoms together with a rectocoele with or without an intussusception, who have failed conservative management, may benefit from a rectal excisional procedure.

Conclusion

Rectal excisional procedures are safe with little major morbidity. It is not possible to advise which excisional technique is superior from the point of view of efficacy, peri-operative variables, or harms. Future study is required.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
R Medicine > RD Surgery
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
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
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:
DateEvent
29 September 2017Published
19 September 2017Accepted
Volume: 19
Number: S3
Page Range: pp. 49-72
DOI: 10.1111/codi.13772
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: 5 October 2017
Funder: National Institute for Health Research (Great Britain) (NIHR)
Grant number: RP-PG-0612-20001

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