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Surgery for constipation: systematic review and practice recommendations
Author(s) -
Knowles C. H.,
Grossi U.,
Horrocks E. J.,
Pares D.,
Vollebregt P. F.,
Chapman M.,
Brown S.,
MercerJones M.,
Williams A. B.,
Yiannakou Y.,
Hooper R. J.,
Stevens N.,
Mason J.
Publication year - 2017
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13775
Subject(s) - medicine , guideline , randomized controlled trial , systematic review , medline , cohort , constipation , observational study , evidence based medicine , family medicine , physical therapy , surgery , alternative medicine , pathology , political science , law
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 RCT s. 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’ GPR s 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 RCT s 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 GPR s 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.