Surgery for constipation: systematic review and practice recommendations: Results I: Colonic resection

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Evidence-Based Medicine

Background:

• Chronic constipation (CC) significantly impacts quality of life.
• Surgical interventions like colectomy are considered for refractory CC.
• Outcomes and risks associated with colectomy for CC require thorough evaluation.

Purpose of the Study:

• To systematically assess the outcomes of colectomy in adult patients diagnosed with chronic constipation.
• To synthesize evidence regarding the benefits and harms of colectomy for CC.
• To evaluate the current evidence base for guiding clinical decisions in colectomy for CC.

Main Methods:

• Systematic review adhering to PRISMA 2016 guidelines.
• Inclusion of 40 articles reporting outcomes in 2045 patients.
• Evidence synthesis using Summary Evidence Statements (SES) with Oxford Centre for Evidence-Based Medicine (2009) levels.

Main Results:

• Colectomy, primarily colectomy and ileorectal anastomosis (CIRA), shows variable outcomes.
• Complications occurred in ~24% of patients, with 0.4% procedure-related deaths.
• Long-term risks include ~15% recurrent small bowel obstruction, necessitating re-hospitalization and further surgery.

Conclusions:

• Colectomy for CC can provide benefits but is associated with considerable short- and long-term morbidity.
• Current evidence is inadequate to inform patient selection or specific procedural choices.
• Further research is needed to clarify optimal surgical strategies and patient selection criteria for CC.