Surgery for constipation: systematic review and practice 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

doi:10.1111/codi.13775

journal article Open Access Sep 01, 2017

Surgery for constipation: systematic review and practice 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

Colorectal Disease Vol. 19 No. S3 pp. 101-113 · Wiley

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Abstract

AbstractAimThis 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).MethodsSummary of review data, development of GPR and future research recommendations as outlined in detail in the ‘introduction and methods’ paper.ResultsThe 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.ConclusionWhile 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.

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References

10

[1]

10.1111/apt.13415

[2]

10.1038/nrgastro.2015.191

[3]

10.1038/ajg.2015.101

[4]

10.1002/bjs.10326

[5]

10.1002/ejp.567

[6]

10.1016/s0140-6736(09)61086-2

[7]

10.1016/s0140-6736(09)61116-8

[8]

ISRCTN.com;SRCTN#11747152.http://www.isrctn.com/ISRCTN11747152.

[9]

10.1016/s0140-6736(07)61602-x

[10]

10.1136/bmj.330.7482.88

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Details

Published: Sep 01, 2017
Vol/Issue: 19(S3)
Pages: 101-113
License: View

Authors

C

C. H. Knowles

National Bowel Research Centre Blizard Institute Queen Mary University London London UK

U

U. Grossi

National Bowel Research Centre Blizard Institute Queen Mary University London London UK

E

E. J. Horrocks

National Bowel Research Centre Blizard Institute Queen Mary University London London UK

D

D. Pares

Hospital Germans Trías i Pujol Barcelona Spain

P

P. F. Vollebregt

National Bowel Research Centre Blizard Institute Queen Mary University London London UK

M

M. Chapman

Good Hope Hospital Heart of England NHS Trust Birmingham UK

S

S. Brown

Sheffield Teaching Hospitals Sheffield UK

M

M. Mercer‐Jones

Queen Elizabeth Hospital Gateshead NHS Trust Gateshead UK

A

A. B. Williams

Guy's and St Thomas’ NHS Foundation Trust London UK

Y

Y. Yiannakou

County Durham and Darlington NHS Foundation Trust Durham UK

R

R. J. Hooper

NIHR Pragmatic Clinical Trials Unit Blizard Institute Queen Mary University of London London UK

N

N. Stevens

NIHR Pragmatic Clinical Trials Unit Blizard Institute Queen Mary University of London London UK

J

J. Mason

University of Warwick Coventry UK

Funding

National Institute for Health Research Award: RP‐PG‐0612‐20001

Cite This Article

C. H. Knowles, U. Grossi, E. J. Horrocks, et al. (2017). Surgery for constipation: systematic review and practice recommendations. Colorectal Disease, 19(S3), 101-113. https://doi.org/10.1111/codi.13775

Surgery for constipation: systematic review and practice recommendations

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