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.
Arebi
N
N
St Mark's Hospital, London, UK. naila.arebi@imperial.ac.uk
Kalli
T
T
Howson
W
W
Clark
S
S
Norton
C
C
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