Surgery for constipation: systematic review and practice recommendations: Results III: Rectal wall excisional...

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Evidence-Based Medicine

Background:

• Chronic constipation significantly impacts quality of life.
• Rectal excisional procedures are utilized for severe cases unresponsive to conservative management.
• Assessing the efficacy and safety of these procedures is crucial.

Purpose of the Study:

• To evaluate the outcomes of rectal excisional procedures in adults suffering from chronic constipation.
• To synthesize evidence on benefits, harms, and procedural variables.

Main Methods:

• Systematic review adhering to PRISMA 2016 guidelines.
• Data extracted from 47 studies involving 8340 patients.
• Outcomes assessed using standardized methods and Oxford Centre for Evidence-Based Medicine levels.

Main Results:

• Procedures averaged 44 minutes with a 3-day length of stay; variations by technique were unclear.
• Overall morbidity was 16.9%, with Contour Transtar showing 8.9%. No mortality reported in 5896 patients.
• Good outcomes reported in 73-80% of patients, with significant improvement in obstructive defecation syndrome scores (68-76%). Faecal urgency (10%) and recurrent prolapse (4.3%) were common adverse events.

Conclusions:

• Rectal excisional procedures demonstrate safety with minimal major morbidity for chronic constipation.
• Current evidence is insufficient to recommend a superior technique regarding efficacy, peri-operative factors, or harms.
• Further high-quality research is necessary to guide clinical decision-making.