Surgery for constipation: systematic review and practice recommendations: Graded practice and future research recommendations

C. H. Knowles*, U. Grossi, E. J. Horrocks, D. Pares, P. F. Vollebregt, M. Chapman, S. Brown, M. Mercer-Jones, A. B. Williams, Y. Yiannakou, R. J. Hooper, N. Stevens, J. Mason, Kenneth Campbell, Kenneth Campbell, Andrew Clarke, Neil Cruickshank, Anthony Dixon, Christopher Emmett, Jon Lacy-ColsonIan Lindsey, Andrew Miller, Sophie Pilkington, Neil Smart, Douglas Tincello, Karen Telford, Donato Altomare, Lars Boenicke, Steen Buntzen, Ken Campbell, Peter Christensen, Andre D'Hoore, Eloy Espin, David Jayne, Oliver Jones, Jens Christian Knapp, Soren Laurberg, Paul Lehur, Klaus Matzel, Ronan O'Connell, Michel Prudhomme, Carlo Ratto, Mario Trompetto, Carolynne Vaizey, the NIHR CapaCiTY working group, The Pelvic floor Society and, European Society of Coloproctology

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Aim: This manuscript forms the final of seven that address the surgical management of chronic constipation (CC) in adults. The content coalesces results from the five systematic reviews that precede it and of the European Consensus process to derive graded practice recommendations (GPR). Methods: Summary of review data, development of GPR and future research recommendations as outlined in detail in the ‘introduction and methods’ paper. Results: The overall quality of data in the five reviews was poor with 113/156(72.4%) of included studies providing only level IV evidence and only four included level I RCTs. Coalescence of data from the five procedural classes revealed that few firm conclusions could be drawn regarding procedural choice or patient selection: no single procedure dominated in addressing dynamic structural abnormalities of the anorectum and pelvic floor with each having similar overall efficacy. Of one hundred ‘prototype’ GPRs developed by the clinical guideline group, 85/100 were deemed ‘appropriate’ based on the independent scoring of a panel of 18 European experts and use of RAND-UCLA consensus methodology. The remaining 15 were all deemed uncertain. Future research recommendations included some potential RCTs but also a strong emphasis on delivery of large multinational high-quality prospective cohort studies. Conclusion: While the evidence base for surgery in CC is poor, the widespread European consensus for GPRs is encouraging. Professional bodies have the opportunity to build on this work by supporting the efforts of their membership to help convert the documented recommendations into clinical guidelines.

Original languageEnglish
Pages (from-to)101-113
Number of pages13
JournalColorectal Disease
Volume19
DOIs
Publication statusPublished - 1 Sep 2017

Cite this

Knowles, C. H., Grossi, U., Horrocks, E. J., Pares, D., Vollebregt, P. F., Chapman, M., ... European Society of Coloproctology (2017). Surgery for constipation: systematic review and practice recommendations: Graded practice and future research recommendations. Colorectal Disease, 19, 101-113. https://doi.org/10.1111/codi.13775