{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:13:38Z","timestamp":1787616818346,"version":"build-2736575974"},"reference-count":10,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2017,9,29]],"date-time":"2017-09-29T00:00:00Z","timestamp":1506643200000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["RP\u2010PG\u20100612\u201020001"],"award-info":[{"award-number":["RP\u2010PG\u20100612\u201020001"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>This manuscript forms the final of seven that address the surgical management of chronic constipation (<jats:styled-content style=\"fixed-case\">CC<\/jats:styled-content>) in adults. The content coalesces results from the five systematic reviews that precede it and of the European Consensus process to derive graded practice recommendations (<jats:styled-content style=\"fixed-case\">GPR<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Summary of review data, development of <jats:styled-content style=\"fixed-case\">GPR<\/jats:styled-content> and future research recommendations as outlined in detail in the \u2018introduction and methods\u2019 paper.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall quality of data in the five reviews was poor with 113\/156(72.4%) of included studies providing only level <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> evidence and only four included level I <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s. Coalescence of data from the five procedural classes revealed that few firm conclusions could be drawn regarding procedural choice or patient selection: no single procedure dominated in addressing dynamic structural abnormalities of the anorectum and pelvic floor with each having similar overall efficacy. Of one hundred \u2018prototype\u2019 <jats:styled-content style=\"fixed-case\">GPR<\/jats:styled-content>s developed by the clinical guideline group, 85\/100 were deemed \u2018appropriate\u2019 based on the independent scoring of a panel of 18 European experts and use of <jats:styled-content style=\"fixed-case\">RAND<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">UCLA<\/jats:styled-content> consensus methodology. The remaining 15 were all deemed uncertain. Future research recommendations included some potential <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s but also a strong emphasis on delivery of large multinational high\u2010quality prospective cohort studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While the evidence base for surgery in <jats:styled-content style=\"fixed-case\">CC<\/jats:styled-content> is poor, the widespread European consensus for <jats:styled-content style=\"fixed-case\">GPR<\/jats:styled-content>s is encouraging. Professional bodies have the opportunity to build on this work by supporting the efforts of their membership to help convert the documented recommendations into clinical guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13775","type":"journal-article","created":{"date-parts":[[2017,9,29]],"date-time":"2017-09-29T12:29:48Z","timestamp":1506688188000},"page":"101-113","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Surgery for constipation: systematic review and practice recommendations"],"prefix":"10.1111","volume":"19","author":[{"given":"C. H.","family":"Knowles","sequence":"first","affiliation":[{"name":"National Bowel Research Centre Blizard Institute Queen Mary University London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Grossi","sequence":"additional","affiliation":[{"name":"National Bowel Research Centre Blizard Institute Queen Mary University London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. J.","family":"Horrocks","sequence":"additional","affiliation":[{"name":"National Bowel Research Centre Blizard Institute Queen Mary University London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Pares","sequence":"additional","affiliation":[{"name":"Hospital Germans Tr\u00edas i Pujol Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. F.","family":"Vollebregt","sequence":"additional","affiliation":[{"name":"National Bowel Research Centre Blizard Institute Queen Mary University London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Good Hope Hospital Heart of England NHS Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Brown","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Mercer\u2010Jones","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Gateshead NHS Trust  Gateshead UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. B.","family":"Williams","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas\u2019 NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Yiannakou","sequence":"additional","affiliation":[{"name":"County Durham and Darlington NHS Foundation Trust Durham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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