Surgery for constipation: systematic review and practice recommendations: Results III: Rectal wall excisional procedures (Rectal Excision). (29th September 2017)

• Record Type: Journal Article
• Authors: Mercer‐Jones, M.; Grossi, U.; Pares, D.; Vollebregt, P. F.; Mason, J.; Knowles, C. H.
• Other Names: Brown Steven investigator.; Campbell Kenneth investigator.; Chapman Mark investigator.; Clarke Andrew investigator.; Cruickshank Neil investigator.; Dixon Anthony investigator.; Emmett Christopher investigator.; Grossi Ugo investigator.; Hooper Richard investigator.; Horrocks Emma investigator.; Knowles Charles investigator.; Lacy‐Colson Jon investigator.; Lindsey Ian investigator.; Mason James investigator.; Mercer‐Jones Mark investigator.; Miller Andrew investigator.; Pares David investigator.; Pilkington Sophie investigator.; Smart Neil investigator.; Stevens Natasha investigator.; Tincello Douglas 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: 49
• Page End: 72
• Publication Date: 2017-09-29
• Subjects: surgery -- constipation -- rectal excision -- STARR -- TRANSTAR; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13772
• Languages: English
• ISSNs: 1462-8910

Abstract

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.