Surgery for constipation: systematic review and practice recommendations: Results II: Hitching procedures for the rectum (rectal suspension). (29th September 2017)

• Record Type: Journal Article
• Authors: Grossi, U.; Knowles, C. H.; Mason, J.; Lacy‐Colson, J.; Brown, S. R.
• Other Names: Campbell Kenneth investigator.; Chapman Mark investigator.; Clarke Andrew investigator.; Cruickshank Neil investigator.; Dixon Anthony investigator.; Emmett Christopher investigator.; Hooper Richard investigator.; Horrocks Emma investigator.; Lindsey Ian investigator.; Mercer‐Jones Mark investigator.; Miller Andrew investigator.; Pares David investigator.; Pilkington Sophie investigator.; Smart Neil investigator.; Stevens Natasha investigator.; Telford Karen investigator.; Vollebregt Paul investigator.; Williams Andrew investigator.; Yiannakou Yan investigator.
• Is Part Of: Colorectal disease. Volume 19(2017)Supplement 3
• Page Start: 37
• Page End: 48
• Publication Date: 2017-09-29
• Subjects: Rectopexy -- chronic constipation -- laparoscopic ventral mesh rectopexy (LVMR) -- robotic ventral mesh rectopexy (RVMR) -- laparoscopic resection rectopexy (LRR) -- open rectopexy (OR); Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13773
• Languages: English
• ISSNs: 1462-8910

Abstract

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.