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

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Clinical Practice Guidelines

Background:

• Chronic constipation (CC) significantly impacts adult quality of life.
• Surgical interventions are considered for refractory CC cases.
• A comprehensive review of surgical management strategies is needed.

Purpose of the Study:

• To synthesize evidence from systematic reviews on surgical CC management.
• To develop graded practice recommendations (GPRs) through a European consensus process.
• To provide evidence-based guidance for surgical CC treatment.

Main Methods:

• Coalescence of data from five preceding systematic reviews.
• Application of the RAND-UCLA consensus methodology.
• Expert panel review and scoring of proposed GPRs.

Main Results:

• The evidence base for surgical CC management is predominantly low-quality (72.4% Level IV evidence).
• No single surgical procedure demonstrated superior efficacy for anorectal and pelvic floor abnormalities.
• 85% of 100 prototype GPRs were deemed appropriate by 18 European experts.

Conclusions:

• Despite a weak evidence base, a strong European consensus exists for GPRs in surgical CC management.
• Professional bodies should support the translation of these GPRs into clinical guidelines.
• Further high-quality research, including prospective cohort studies, is recommended.