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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
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WRAP-surgery-constipation-systematic-practice-rectal-excisional-Mason-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1631Kb) | Preview |
Official URL: http://dx.doi.org/10.1111/codi.13772
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 | ||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of 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. 49-72 | ||||||
| DOI: | 10.1111/codi.13772 | ||||||
| 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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