Surgery for constipation: systematic review and practice recommendations: Results I: Colonic resection.
TLDR
To assess the outcomes of colectomy in adults with chronic constipation, a large number of subjects were referred to hospital for treatment with standard constipation-like symptoms.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 (04%) 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 selectionread more
Citations
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Journal ArticleDOI
Mechanisms, Evaluation, and Management of Chronic Constipation
Adil E. Bharucha,Brian E. Lacy +1 more
TL;DR: The importance of meticulous analyses of patients' histories and physical examination is discussed, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients are discussed.
Journal ArticleDOI
Management of functional constipation in children and adults.
TL;DR: An overview of the differing management strategies for childhood and adult functional constipation is provided, including insights into epidemiology, pathophysiology, diagnosis and therapy.
Journal ArticleDOI
An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation
TL;DR: By adopting a logical step-wise approach toward the diagnosis of chronic constipation and its individual subtypes, clinicians have the opportunity to tailor therapy accordingly and improve symptoms, quality of life, and patient satisfaction.
Journal ArticleDOI
European society of neurogastroenterology and motility guidelines on functional constipation in adults.
Jordi Serra,Daniel Pohl,Fernando Azpiroz,Giuseppe Chiarioni,Philippe Ducrotté,Guillaume Gourcerol,A Pali S Hungin,Peter Layer,Juan-Manuel Mendive,Johann Pfeifer,Gerhard Rogler,S. Mark Scott,Magnus Simren,Peter J. Whorwell +13 more
TL;DR: The aim was to develop European guidelines for the clinical management of constipation with a reported prevalence ranging from 3% to 27% in the general population.
Journal ArticleDOI
Chronic constipation: new insights, better outcomes?
TL;DR: In all patients with constipation, rectal outlet dysfunction should be excluded by physical examination because this condition occurs in approximately 25% of patients diagnosed with idiopathic constipation and can be improved with different therapeutic approaches than administration of laxatives.
References
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From the authors
Y. Lacasse,F. Maltais +1 more
TL;DR: Findings, i.e. that as-needed AO provided for a period of 3 months had no effect on quality of life and walked distance, are against the stream of current guidelines.
Journal ArticleDOI
Long-term results of surgery for chronic constipation
TL;DR: Physiologic evaluation reliably identified patients with severe chronic constipation who might benefit from surgery, and IRA is safe and effective, resulting in prompt and prolonged relief of constipation.
Journal ArticleDOI
Outcome of colectomy for severe idiopathic constipation.
TL;DR: The preoperative abnormalities of paradoxical contraction of the pelvic floor during straining and impaired rectal evacuation of a water filled balloon did not correlate with the outcome of colectomy, and patients continued to experience abdominal pain after surgery.
Journal ArticleDOI
Evaluation and surgical treatment of severe chronic constipation.
TL;DR: A prospective evaluation of colonic and pelvic floor function reliably delineated constipated patients with slow transit, suitable for operative management, from those with pure pelvic floor dysfunction or irritable bowel syndrome, who were not.
Journal ArticleDOI
Outcome of Colectomy for Slow Transit Constipation
TL;DR: It may be possible to predict outcome on the basis of preoperative clinical and pathophysiologic findings and on the type of study, the population studied, and the surgical procedure used.