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Role of transanal irrigation in the treatment of anterior resection syndrome

Techniques in Coloproctology volume 22, pages 519–527 (2018)Cite this article

Abstract

Background

Transanal irrigation(TAI) has been reported to be an inexpensive and effective treatment for low anterior resection syndrome(LARS). The aim of the present prospective study was to evaluate the use of TAI in patients with significant LARS symptoms at a single medical center.

Methods

Patients who had low anterior resection for rectal cancer between April 2015 and May 2016 at the Careggi University Hospital were assessed for LARS using the LARS and the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (MSKCC BFI) questionnaires 30–40 days after  surgery or ileostomy closure (if this was done). Quality of life was evaluated using a visual analog scale and the Short Form-36 Health Survey. All patients with LARS score of 30 or higher were included (early LARS) as were all patients with a LARS score of 30 or higher referred 6 months or longer after surgery performed elsewhere (chronic LARS) in the same study period. Study participants were trained to perform TAI using the Peristeen™ System for 6 months, followed by 3 months of enema therapy following a similar protocol.

Results

Thirty-three patients were enrolled in the study. Six patients stopped the treatment. The 27 patients (19 early LARS and 8 chronic LARS) who completed the study had a significant decrease in the number of median daily bowel movements [baseline 7 (range 0–14); 6 months 1 (range 0–4); 9 months 4 (range 0–13)]. The median LARS Score fell from 35.1 (range 30–42) (baseline) to 12.2 (range 0–21) after 6 months (p < 0.0001) and then rose to 27 (range 5–39) after 3 months of enema therapy. There was no difference in LARS score decrease at 6 months between the patients with early and chronic LARS (22.5 and 23.9 respectively; p=0.7) and there were no predictors of score decrease. Four components of the SF-36 significantly improved during the TAI period. The MSKCC BFI score significantly improved in several domains. Twenty-three patients (85%) asked to continue the treatment with TAI after the study ended.

Conclusions

TAI appears to be an effective treatment for LARS and results in a marked improvement of continence and quality of life.  Patients may be assessed and treated for LARS early after surgery since the treatment benefit is similar to that observed in patients with LARS diagnosed  6 months or longer after surgery. The potential rehabilitative role of TAI for LARS is promising and should be further investigated.

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Author information

Affiliations

  1. General Emergency and Minimally Invasive Surgery, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy

    J. Martellucci, A. Sturiale, C. Bergamini & A. Valeri

  2. Clinical Trial Center, Careggi University Hospital, Florence, Italy

    L. Boni

  3. General and Endocrine Surgery, Careggi University Hospital, Florence, Italy

    F. Cianchi

  4. Oncologic and Robotic Surgery, Careggi University Hospital, Florence, Italy

    A. Coratti

Authors
  1. J. Martellucci
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  2. A. Sturiale
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  3. C. Bergamini
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  4. L. Boni
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  5. F. Cianchi
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  6. A. Coratti
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  7. A. Valeri
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Contributions

MJ, SA, and BC substantially contributed to the conception and design of the study, acquisition, analysis and interpretation of data; MJ, SA, BC, CF, CA, VA (all authors) drafted the article and made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.

Corresponding author

Correspondence to J. Martellucci.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was reviewed and approved by the local Ethics Committee.

Informed consent

Informed consent was obtained from all participants included in the study.

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Martellucci, J., Sturiale, A., Bergamini, C. et al. Role of transanal irrigation in the treatment of anterior resection syndrome. Tech Coloproctol 22, 519–527 (2018). https://doi.org/10.1007/s10151-018-1829-7

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  • DOI: https://doi.org/10.1007/s10151-018-1829-7

Keywords

  • Rectal cancer
  • Anterior resection
  • Low anterior resection syndrome
  • Anterior resection syndrome
  • Functional disorders
  • Transanal irrigation