Does Bariatric Surgery Improve Faecal Incontinence? A Systematic Review and Meta-analysis
INTRODUCTION: Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported.
OBJECTIVE: To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity.
METHODS: This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird's variance estimator were used for meta-analysis.
RESULTS: Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =-0.17, 95% CI -0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour -0.35, 95% CI -0.94 to 0.24; depression 0.04, 95% CI -0.12 to 0.2; lifestyle -0.33, 95% CI -0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively].
DISCUSSION: There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Obesity surgery - 31(2021), 7 vom: 14. Juli, Seite 2942-2953 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mohamed, Fardowsa [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 25.06.2021 Date Revised 25.06.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s11695-021-05360-7 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Mohamed, Fardowsa |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Does Bariatric Surgery Improve Faecal Incontinence? A Systematic Review and Meta-analysis |
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| 500 | |a Date Completed 25.06.2021 | ||
| 500 | |a Date Revised 25.06.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a INTRODUCTION: Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported | ||
| 520 | |a OBJECTIVE: To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity | ||
| 520 | |a METHODS: This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird's variance estimator were used for meta-analysis | ||
| 520 | |a RESULTS: Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =-0.17, 95% CI -0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour -0.35, 95% CI -0.94 to 0.24; depression 0.04, 95% CI -0.12 to 0.2; lifestyle -0.33, 95% CI -0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively] | ||
| 520 | |a DISCUSSION: There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Bariatric surgery | |
| 650 | 4 | |a Biliopancreatic diversion | |
| 650 | 4 | |a Duodenal switch | |
| 650 | 4 | |a Faecal incontinence | |
| 650 | 4 | |a Gastrectomy | |
| 650 | 4 | |a Gastrointestinal health | |
| 650 | 4 | |a Obesity | |
| 650 | 4 | |a Pelvic floor disorder | |
| 650 | 4 | |a Pelvic organ prolapse | |
| 650 | 4 | |a Roux-en-Y gastric bypass | |
| 650 | 4 | |a Urinary incontinence | |
| 700 | 1 | |a Jeram, Megna |e verfasserin |4 aut | |
| 700 | 1 | |a Coomarasamy, Christin |e verfasserin |4 aut | |
| 700 | 1 | |a Lauti, Melanie |e verfasserin |4 aut | |
| 700 | 1 | |a Wilson, Don |e verfasserin |4 aut | |
| 700 | 1 | |a MacCormick, Andrew D |e verfasserin |4 aut | |
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