Abstract
Background
Low anterior resection for rectal cancer often results in severe bowel dysfunction, specifically low anterior resection syndrome (LARS), with symptoms such as incontinence, urgency, and frequent bowel movements. Percutaneous tibial nerve stimulation (PTNS) resulted in a high rate of success in patients with fecal incontinence. The aim of this study was to evaluate the effectiveness of treatment with PTNS in LARS and to identify predictors of the outcome of the technique.
Methods
The study was conducted from May 2012 to April 2015 at the Alvaro Cunqueiro Hospital, University Hospital Complex of Vigo, Spain. Ten patients with LARS were recruited consecutively. All patients underwent 2 sessions per week (30 min each one) for 6 weeks. Patients were followed for 3 weeks, and those who had a significant clinical improvement were recruited to a second phase of PTNS. Some patients presenting with relapse during follow-up underwent an additional phase of PTNS. Outcome measures included Wexner scores, quality of life scores, and urgency of defecation.
Results
Three patients did not complete the treatment due to poor response in the first phase. Incontinence was reduced in the remaining seven of ten patients. The median Wexner score at initial patient evaluation was 14 (IQR 10.75–18.5), which decreased to 10 (IQR 6.5–18) after treatment (p = 0.034). A statistically significant improvement was demonstrated in quality of life scale, lifestyle, depression, and daily defecation urgency (p < 0.05). LARS Score improvement was observed in five patients (50%) with a total resolution of LARS in 2 (20%).
Conclusions
PTNS is an ambulatory treatment that could play an important role in the context of a multimodal treatment approach in patients with LARS. It could be a first-line treatment to identify non-responders to conservative management who need different and more invasive treatments.
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Acknowledgements
This manuscript has been presented as Poster at “European Society of Coloproctology Dublin 2015 10th Anniversary Meeting,” Dublin, Ireland, September 23–25, 2015, and is not under consideration for publication elsewhere.
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Study concept and design: VV; drafting of the manuscript: VV, SR, and ASP; acquisition of data and treatment of patients: VV, PTP, ARP, IT, EMI, CFA, and ASP; critical revision of the manuscript for important intellectual content: ECN. All authors have approved the final draft submitted for publication.
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This study has been approved by the appropriate ethics committee.
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All subjects gave their informed consent prior to their inclusion in the study.
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Vigorita, V., Rausei, S., Troncoso Pereira, P. et al. A pilot study assessing the efficacy of posterior tibial nerve stimulation in the treatment of low anterior resection syndrome. Tech Coloproctol 21, 287–293 (2017). https://doi.org/10.1007/s10151-017-1608-x
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DOI: https://doi.org/10.1007/s10151-017-1608-x