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Comparing the short-term clinical outcomes and therapeutic effects of different colectomies in patients with refractory slow-transit constipation in eastern countries: a network meta-analysis

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Abstract

Surgical treatment has been widely used in patients with refractory slow transit constipation (RSTC). The aim of this network meta-analysis (NMA) was to compare the effects of different colectomies on short-term postoperative complications and quality of life in patients with RSTC. Electronic literature searches were performed in the PubMed, Web of Science, EMBASE, WANFANG DATA, and Cochrane Central Register of controlled trials databases and were searched up to December 2022. Selected to compare the short-term clinical outcomes and quality of life of the treatment of RSTC. A random-effects Bayesian NMA was conducted to assess and rank the effectiveness of different surgical modalities. This study included a total of six non-randomized controlled trials involving 336 subjects. It was found that subtotal colectomy with cecorectal anastomosis (CRA) demonstrated superior effectiveness in several aspects, including reduced hospital stay (MD 0.06; 95% CI [0.02, 1.96]), shorter operative time (MD 4.75; 95% CI [0.28, 14.07]), lower constipation index (MD 0.61; 95% CI [0.04, 1.71]), improved quality of life (MD 4.42; 95% CI [0.48, 4.42]). Additionally, in terms of short-term clinical outcomes, subtotal colectomy with ileosigmoidal anastomosis (SC-ISA) procedure ranked the highest in reducing small bowel obstruction (OR 0.24; 95% CI [0.02, 0.49]), alleviating abdominal pain (OR 0.53; 95% CI [0.05, 1.14]), minimizing abdominal distension (OR 0.33; 95% CI [0.02, 0.65]), and reducing incision infection rates (OR 0.17; 95% CI [0.01, 0.33]). Furthermore, SC-ISA ranked as the best approach in terms of patient satisfaction (OR 0.66; 95% CI [0.02, 1.46]). Based on our research findings, we recommend that CRA be considered as the preferred treatment approach for patients diagnosed with RSTC.

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The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.

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Funding

This work was supported by Longyan City Joint Funding (FLY2020CWS020046), Natural Science Foundation of Fujian Province (2021J01122670), Lanyan City Joint Funding (2022LYF17094).

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Authors and Affiliations

  1. Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China

    Xueyi Xue, Hao Zeng, Dongbo Chen, Biaohui Zheng, Baofeng Liang, Dongbo Xu & Shuangming Lin

  2. Fujian Medical University, Fuzhou, China

    Hao Zeng

  3. Department of Outpatient Services, Shanghang County Hospital, Longyan, Fujian, China

    Baofeng Liang

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Contributions

Conception and design: SL, XX; collection and assembly of data: XX, HZ, DC; data analysis and interpretation: XX, HZ, DC, BZ; manuscript writing: XX, HZ, BL; final approval of manuscript: SL, DX.

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Correspondence to Shuangming Lin.

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Xue, X., Zeng, H., Chen, D. et al. Comparing the short-term clinical outcomes and therapeutic effects of different colectomies in patients with refractory slow-transit constipation in eastern countries: a network meta-analysis. Updates Surg 76, 411–422 (2024). https://doi.org/10.1007/s13304-024-01762-1

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