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Sacral neuromodulation for low anterior resection syndrome: current status—a systematic review and meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

It is estimated that approximately 70% of patients with rectal cancer who undergo surgery will suffer from Low Anterior Resection Syndrome (LARS). In the last decades, sacral neuromodulation (SNM) has been widely used in urinary dysfunction and in faecal incontinence refractory to medical treatment. Its application in LARS has been investigated and has shown promising results. The paper’s aim is to present a systematic review and meta-analysis of the available literature and evaluate the therapeutic success of SNM in patients with LARS.

Methods

A systematic search was performed in international health-related databases: Cochrane Library, EMBASE, PubMed and SciELO. No restrictions on year of publication or language were applied. Retrieved articles were screened and selected according to set inclusion criteria. Data items were collected and processed for each included article and a meta-analysis was done according to the PRISMA guidelines. The primary outcome was the number of successful definitive SNM implants. Further outcomes included changes in bowel habits, incontinence scores, quality of life scores, anorectal manometry data and complications.

Results

A total of 18 studies were included, with 164 patients being submitted to percutaneous nerve evaluation (PNE) with 91% responding successfully. During follow-up of therapeutic SNM some devices were explanted. The final clinical success rate was 77% after permanent implant. Other outcomes, such as the frequency of incontinent episodes, faecal incontinence scores, quality of life scores were overall improved after SNM. The meta-analysis showed a decrease in 10.11 incontinent episodes/week; a decrease of 9.86 points in the Wexner score and an increase in quality of life of 1.56 (pooled estimate). Changes in anorectal manometry were inconsistent. Local infection was the most common post-operative complication, followed by pain, mechanical issues, loss of efficacy and haematoma.

Discussion/conclusion

This is the largest systematic review and meta-analysis concerning the use of SNM in LARS patients. The findings support the available evidence that sacral neuromodulation can be effective in the treatment of LARS, with significant improvement in total incontinent episodes and patients´ quality of life.

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Data availability

The data supporting the findings of this paper are available within the article and its supplementary materials.

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Authors and Affiliations

  1. Serviço de Cirurgia Geral, Departamento de Cirurgia, Porto, CHUdSA, Portugal

    Marco Pires

  2. ICBAS-UP–School of Medicine and Biomedical Sciences, Porto, Portugal

    Milton Severo, Sílvia Neves & Ana Povo

  3. Academic Clinical Center ICBAS–CHUdSA, Porto, Portugal

    Milton Severo & Ana Povo

  4. Serviço de Urologia, Departamento de Cirurgia, Porto, CHUdSA, Portugal

    Ana Lopes

  5. Serviço de Cirurgia Geral de Ambulatório, Departamento de Cirurgia, Porto, CHUdSA, Portugal

    Sílvia Neves & Ana Povo

  6. Section of Coloproctology, Department of Surgery, University of Erlangen, Erlangen, Germany

    Klaus Matzel

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Contributions

Marco Pires, Sílvia Neves and Ana Povo did the article research and selection and data evaluation. Milton Severo did the main statistical analysis. Marco Pires and Ana Lopes wrote the main manuscript. Klaus Matzel and Ana Povo reviewed the manuscript. All authors read and approved the final manuscript.

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Correspondence to Marco Pires.

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The authors Marco Pires, Milton Severo, Ana Lopes, Sílvia Neves and Ana Povo have no conflicts of interest associated with this publication. Klaus Matzel is a medical advisor for Medtronic. All other authors declare that they have no conflict of interest.

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Pires, M., Severo, M., Lopes, A. et al. Sacral neuromodulation for low anterior resection syndrome: current status—a systematic review and meta-analysis. Int J Colorectal Dis 38, 189 (2023). https://doi.org/10.1007/s00384-023-04485-8

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