Surgery for constipation: systematic review and practice recommendations

Abstract

Aim To assess the outcomes of rectal excisional procedures in adults with chronic constipation.Method Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level.Results Forty-seven studies were identified, providing data on outcomes in 8340 patients. Average length of procedures was 44 min and length of stay (LOS) was 3 days. There was inadequate evidence to determine variations in procedural duration or LOS by type of procedure. Overall morbidity rate was 16.9% (0-61%), with lower rates observed after Contour Transtar procedure (8.9%). No mortality was reported after any procedures in a total of 5896 patients. Although inconsistently reported, good or satisfactory outcome occurred in 73-80% of patients; a reduction of 53-91% in Longo scoring system for obstructive defecation syndrome (ODS) occurred in about 68-76% of patients. The most common long-term adverse outcome is faecal urgency, typically occurring in up to 10% of patients. Recurrent prolapse occurred in 4.3% of patients. Patients with at least 3 ODS symptoms together with a rectocoele with or without an intussusception, who have failed conservative management, may benefit from a rectal excisional procedure.Conclusion Rectal excisional procedures are safe with little major morbidity. It is not possible to advise which excisional technique is superior from the point of view of efficacy, peri-operative variables, or harms. Future study is required.

Anorectal angle at rest predicting successful sacral nerve stimulation in idiopathic fecal incontinence—a cohort analysis

“…The presented study cohort included eleven patients, who underwent the STARR procedure before SNS implantation. Although a current systematic review showed no evidence of the STARR procedure contributing to FI on the basis of level II evidence, urge symptoms after STARR are described in 0-34%, and de novo FI in up to 9% in individual cohorts [12,18,19]. While small rectal diameter and increased pelvic floor descent in defecography predict FI after STARR, the effect of STARR on the outcome of SNS has not been studied yet [12].…”

Pneumoretroperitoneum after a STARR Procedure Performed One Year after a Posterior Colporrhaphy: A Case Report and Review of the Literature

“…The efficacy and safety of the STARR procedure using the Contour Transtar curved cutter stapler to treat ODS in the presence of a rectocele and/or intussusception have been supported by several prospective trials, including randomized trials and meta-analyses [1, 5]. The randomized controlled trials reported in these meta-analyses did not find significant differences regarding the complication rates when the Contour Transtar was compared to STARR performed with circular staplers like PPH01 (Ethicon Endo-Surgery).…”

Aktualisierte S2k-Leitlinie chronische Obstipation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie & Motilität (DGNM) – April 2022 – AWMF-Registriernummer: 021–019

“…Die Erfolgsrate liegt bei 73–80 % und die perioperativen Komplikationen bei 13–22 %. Schwerwiegende Komplikationen wie Blutung, Anastomoseninsuffizienz oder Sepsis sind selten (2 %) beschrieben 473 . Langzeitdaten zeigen einen nachlassenden funktionellen Effekt im Verlauf 474 475 .…”