Surgery for constipation: systematic review and practice recommendations: Results I: Colonic resection. (29th September 2017)

• Record Type: Journal Article
• Authors: Knowles, C. H.; Grossi, U.; Chapman, M.; Mason, J.
• Other Names: Brown Steven investigator.; Campbell Kenneth investigator.; Clarke Andrew investigator.; Cruickshank Neil investigator.; Dixon Anthony investigator.; Emmett Christopher investigator.; Hooper Richard investigator.; Horrocks Emma investigator.; Lacy‐Colson Jon investigator.; Lindsey Ian 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: 17
• Page End: 36
• Publication Date: 2017-09-29
• Subjects: Constipation -- colectomy -- ileorectal -- slow‐transit; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13779
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: To assess the outcomes of colectomy in adults with chronic constipation (CC). 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 (SES) with a summative Oxford Centre for Evidence‐Based Medicine (2009) level. Results: Forty articles were identified, providing data on outcomes in 2045 patients. Evidence was derived almost exclusively from observational studies, the majority of which concerned colectomy and ileorectal anastomosis (CIRA) rather than other procedural variations. Average length of stay (LOS) ranged between 7–15 days. Although inconsistent, laparoscopic surgery may be associated with longer mean operating times (210 vs 167 min) and modest decreases in LOS (10–8 days). Complications occurred in approximately 24% of patients. Six (0.4%) procedure‐related deaths were observed. Recurrent episodes of small bowel obstruction occurred in about 15% (95%CI: 10–21%) of patients in the long‐term, with significant burden of re‐hospitalisation and frequent recourse to surgery. Most patients reported a satisfactory or good outcome after colectomy but negative long‐term functional outcomes persist in a minority of patients. The influence of resection extent, anastomotic configuration and method of access on complication rates remains uncertain. Available evidence weakly supports selection of patients with an isolated slow‐transit phenotype. Conclusion: Colectomy for CC may benefit some patients but at the cost of substantial short‐ and long‐term morbidity. Current evidence is insufficient to guide patient or procedural selection.