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01.12.2024 | Challenges in Coloproctology

Preventative strategies for low anterior resection syndrome

verfasst von: H. Brock, L. Lambrineas, H. I. Ong, W. Y. Chen, A. Das, A. Edsell, D. Proud, E. Carrington, P. Smart, H. Mohan, A. Burgess

Erschienen in: Techniques in Coloproctology | Ausgabe 1/2024

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Abstract

Background

A common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly understood and challenging to treat. Despite this, prevention strategies are commonly overlooked. Our aim was to review the pathophysiology of LARS and explore current evidence on the efficacy and feasibility of prophylactic techniques.

Methods

A literature review was performed between [1st January 2000 to 1st October 2023] for studies which investigated preventative interventions for LARS. Mechanisms by which LARS develop are described, followed by a review of prophylactic strategies to prevent LARS. Medline, Cochrane, and PubMed databases were searched, 189 articles screened, 8 duplicates removed and 18 studies reviewed.

Results

Colonic dysmotility, anal sphincter dysfunction and neorectal dysfunction all contribute to the development of LARS, with the complex mechanism of defecation interrupted by surgery. Transanal irrigation (TAI) and pelvic floor rehabilitation (PFR) have shown benefits in preventing LARS, but may be limited by patient compliance. Intraoperative nerve monitoring (IONM) and robotic-assisted surgery have shown some promise in surgically preventing LARS. Nerve stimulation and other novel strategies currently used in treatment of LARS have yet to be investigated in their roles prophylactically.

Conclusions

To date, there is a limited evidence base for all preventative strategies including IONM, RAS, PFP and TAI. These strategies are limited by either access (IONM, RAS and PFP) or acceptability (PFP and TAI), which are both key to the success of any intervention. The results of ongoing trials will serve to assess acceptability, while technological advancement may improve access to some of the aforementioned strategies.

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Titel: Preventative strategies for low anterior resection syndrome
verfasst von: H. Brock
L. Lambrineas
H. I. Ong
W. Y. Chen
A. Das
A. Edsell
D. Proud
E. Carrington
P. Smart
H. Mohan
A. Burgess
Publikationsdatum: 01.12.2024
Verlag: Springer International Publishing
Erschienen in: Techniques in Coloproctology / Ausgabe 1/2024
Print ISSN: 1123-6337
Elektronische ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-023-02872-5

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