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Surgery for constipation: systematic review and clinical guidance: Paper 1: Introduction & Methods
C H Knowles1, U Grossi1, E J Horrocks1
1National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK.
Summary
Surgical interventions for chronic constipation in adults have a poor evidence base. Expert consensus exists on best practices, but further research is needed to guide future treatments and funding.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Evidence-Based Medicine
Background:
- Chronic constipation affects a significant adult population.
- Surgical interventions are employed, but their efficacy and safety require rigorous assessment.
- Developing evidence-based guidelines for surgical management is crucial.
Purpose of the Study:
- To introduce the methodology for systematic reviews on surgical treatments for chronic constipation.
- To assess the outcomes of surgical interventions for adult chronic constipation.
- To develop evidence-based recommendations for clinical practice.
Main Methods:
- Adherence to PRISMA guidelines for systematic reviews.
- Comprehensive literature search from 1960 to 2016.
- Inclusion of studies meeting strict PICOS criteria.
- Systematic reviews conducted by a UK clinical guidance group.
- Evaluation of recommendations by a European Consensus group using RAND/UCLA methodology.
Main Results:
- 156 studies were included, covering colonic resection, rectal suspension, rectal wall excision, rectovaginal septum reinforcement, and sacral nerve stimulation.
- The overall quality of evidence was poor (72.4% were Oxford Level IV).
- 99 summary evidence statements (SES) and 100 prototype graded practice recommendations (GPRs) were generated.
- 85 GPRs were deemed appropriate by European Consensus.
Conclusions:
- The current evidence base for surgical management of chronic constipation is inadequate.
- Expert consensus provides some guidance on best practices.
- Further high-quality studies are essential for informed treatment decisions and research funding allocation.
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