Systematic review of abdominal surgery for chronic idiopathic constipation.
OBJECTIVE
Constipation is a common problem which increases in prevalence with age. Chronic constipation is complex and difficult to treat. Some patients will not respond to pharmacological therapy and therefore surgery may be considered. A systematic review of the literature was performed to determine the outcome of surgery.


METHODS
Published papers were identified by a search of The Cochrane Library, MEDLINE, CINAHL and EMBASE. They were reviewed and the data were extracted.


RESULTS
Forty-eight papers were identified, including 1443 patients. Eleven different procedures were described. There was inconsistency in reporting. In 65% of patients the mean frequency of defaecation increased from 1.1 to 19.7 evacuations per week. Where laxative usage was reported (971 patients), it was found that 88% of patients did not need them postoperatively. Early complications included ileus (0-16%), infection (0-13%) and anastomotic leakage (0-22%). Patient satisfaction and quality of life scores were high. Only 30% of studies included data on preoperative psychological assessment.


CONCLUSIONS
Surgery improves constipation and is associated with a higher degree of patient satisfaction, but the quality of studies was very variable. Future controlled trials should examine the ideal therapeutic approach for different patient groups.
St Mark's Hospital, London, UK. naila.arebi@imperial.ac.uk
N
N
Arebi
T
T
Kalli
W
W
Howson
S
S
Clark
C
C
Norton
D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy / Q000601:surgery*; D003672:Defecation; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life
D054368:Laxatives