Systematic review of abdominal surgery for chronic idiopathic constipation

Colorectal Dis. 2011 Dec;13(12):1335-43. doi: 10.1111/j.1463-1318.2010.02465.x.

Abstract

Aim: 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.

Method: 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.

Conclusion: 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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Chronic Disease
  • Constipation / drug therapy
  • Constipation / surgery*
  • Defecation*
  • Humans
  • Laxatives / therapeutic use
  • Patient Satisfaction
  • Postoperative Complications / etiology*
  • Quality of Life

Substances

  • Laxatives