Abstract
To assess the outcomes of rectal suspension procedures (forms of rectopexy) in adults with chronic constipation. 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. Eighteen articles were identified, providing data on outcomes in 1238 patients. All studies reported only on laparoscopic approaches. Length of procedures ranged between 1.5 to 3.5h, and length of stay between 4 to 5days. Data on harms were inconsistently reported and heterogeneous, making estimates of harm tentative and imprecise. Morbidity rates ranged between 5-15%, with mesh complications accounting for 0.5% of patients overall. No mortality was reported after any procedures in a total of 1044 patients. Although inconsistently reported, good or satisfactory outcome occurred in 83% (74-91%) of patients; 86% (20-97%) of patients reported improvements in constipation after laparoscopic ventral mesh rectopexy (LVMR). About 2-7% of patients developed anatomical recurrence. Patient selection was inconsistently documented. As most common indication, high grade rectal intussusception was corrected in 80-100% of cases after robotic or LVMR. Healing of prolapse-associated solitary rectal ulcer syndrome occurred in around 80% of patients after LVMR. Evidence supporting rectal suspension procedures is currently derived from poor quality studies. Methodologically robust trials are needed to inform future clinical decision making.
Highlights
Background and procedural variationsConstipation, in a proportion of patients and in the broad sense of the term, is related to an inability to evacuate the rectum
Evidence supporting rectal suspension procedures is currently derived from poor quality studies
This obstructed defaecation or rectal evacuation disorder is characterized by excessive straining, the feeling of incomplete evacuation, post-defaecatory seepage and often mucous discharge and pelvic pain [1]
Summary
Constipation, in a proportion of patients and in the broad sense of the term, is related to an inability to evacuate the rectum This obstructed defaecation or rectal evacuation disorder is characterized by excessive straining, the feeling of incomplete evacuation, post-defaecatory seepage and often mucous discharge and pelvic pain [1]. In some of these patients there is clinical and proctographic evidence of a rectocoele and/or intussusception. The potential for worsening constipation is thought to relate to fibrosis caused by insertion of foreign material or mobilization of the lateral ligaments of the rectum. Laparoscopy has become the favoured approach procedurally, allowing a more rapid recovery and easing access to, and visibility in the pelvis
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