Surgery for constipation: systematic review and practice recommendations: Results III: Rectal wall excisional procedures (Rectal Excision)

M. Mercer-Jones, U. Grossi, D. Pares, Paul Vollebregt, J. Mason, C. H. Knowles, Steven Brown, Kenneth Campbell, Mark Chapman, Andrew Clarke, Neil Cruickshank, Anthony Dixon, Christopher Emmett, Ugo Grossi, Richard Hooper, Emma Horrocks, Charles Knowles, Jon Lacy-Colson, Ian Lindsey, James MasonMark Mercer-Jones, Andrew Miller, David Pares, Sophie Pilkington, Neil Smart, Natasha Stevens, Douglas Tincello, Karen Telford, Paul Vollebregt, Andrew Williams, Yan Yiannakou, the NIHR CapaCiTY working group, the Pelvic floor Society

Research output: Contribution to journalReview articleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)49-72
Number of pages24
JournalColorectal Disease
Volume19
DOIs
Publication statusPublished - 1 Sep 2017

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