A randomized trial comparing transanal irrigation and percutaneous tibial nerve stimulation in the management of low anterior resection syndrome

Abstract

Aim To assess the effectiveness of transanal irrigation (TAI) compared with posterior tibial nerve stimulation (PTNS) in severe and chronic low anterior resection syndrome (LARS). Method A two‐group parallel, open‐label randomized controlled trial carried out in a single university hospital. The study population included patients with a LARS scale score of more than 29 points who had undergone rectal surgery more than 1 year previously. These were randomly allocated, with a central randomization system, following a 1:1 sequence to TAI or PTNS. The main study outcome was to achieve a reduction of at least one LARS grade in at least 50% of the patients, for each intervention. Results A total of 27 patients (TAI = 13, PTNS = 14) were randomized. Both groups were similar with regard to confounding factors. Four patients were excluded because of intercurrent disease or early dropout, leaving 23 (TAI, n = 10; PTNS, n = 13) for analysis. Eight out of 10 and 4 out of 13 patients were downgraded with TAI and PTNS, respectively. The median LARS score decreased from 35 [interquartile range (IQR) 32–39] to 12 (IQR 12–26) (P = 0.021) for the TAI group and from 35 (IQR 34–37) to 30 (IQR 25–33) (P = 0.045) for the PTNS group. The Vaizey score fell from 15 (IQR 11–18) to 6 (IQR 4–7) (P = 0.037) and from 14 (IQR 13–17) to 9 (IQR 7–10) (P = 0.007) with TAI and PTNS, respectively, with 80% and 38% of patients, respectively, showing decreases of more than 50%. Improvement in quality of life was observed in both groups. Conclusion Both treatments improved the LARS score in this study but this was only significant in the TAI group.

Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review

“…In total, seven studies were identified reporting data on the effect of TAI in patients with LARS [38][39][40][41][42][43][44]. Results are presented in Table 2.…”

“…The articles were published between 1989 and 2020. Five studies investigated TAI as a treatment for LARS [38][39][40][41][42], and two studies investigated TAI as a prophylactic treatment for LARS immediately after ileostomy closure [43,44].…”

“…One RCT and four prospective cohort studies investigated TAI as a treatment for patients diagnosed with LARS [38][39][40][41][42]. Two studies hadshort FU [41,42], one had long FU [40], one had mixed FU [39] and one did not report any FU [38]. In total, 96 patients using TAI were included, with between 10 and 33 patients in each study.…”

“…In total, 96 patients using TAI were included, with between 10 and 33 patients in each study. Four studies reported reasons for LARS, and the primary reason for LARS was resection for rectal cancer (89%) [39][40][41][42]. One study reported the operation type.…”

Comparation of Laparoscopic Intersphincteric Resection and Abdominoperineal Resection for Ultra-Low Rectal Cancer Patients - a Retrospective Analysis, and a Meta-analysis of Oncology Outcome

“…Previous studies have shown that LAR and especially ISR often lead to severe functional problems both in short and long term and may result in a poor defecatory function. Patients with very low anastomoses are especially prone to develop a condition termed "low anterior resection syndrome" [18], which incorporates a number of unpleasant symptoms such as frequent defecation, urgency, and stool incontinence, and severely impairs QoL. These commonly occurring problems after deep sphincterpreserving surgery are probably the reason why recent studies have shown that QoL after ISR and LAR, contrary to former beliefs, is not better than QoL after APR.…”