Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations

Abstract

Between 25 and 80% of patients undergoing a low or very low anterior resection will suffer postoperatively, from a constellation of symptoms including fecal urgency, frequent bowel movements, bowel fragmentation and incontinence, collectively referred to as the low anterior resection syndrome (LARS). The etiology of LARS is multifactorial with the potential of sphincter injury during anastomosis construction, alterations in anorectal physiology, the development of a pudendal neuropathy, and a lumbar plexopathy with exacerbation of symptoms if there is associated anastomotic sepsis or the use of adjuvant and neoadjuavnt therapies. The symptoms of LARS may be obviated in part by the construction of a neorectal reservoir which may take the form of a colonic J-pouch, a transverse coloplasty, or a side-to-end anastomosis. This review outlines the factors contributing to LARS symptomatology along with the short- and medium-term functional results of comparative trials with the different types of neorectal reconstructions.

Anorectal functional outcome following laparoscopic low anterior resection for rectal cancer

“…These differences may be largely explained by the hypothesis that the LA group patients are more prone to develop what is referred to as the 'LAR syndrome', which comprises frequent defecation, fecal urgency and stool incontinence. Several previous studies have closely associated poor QoL with low anastomosis (32,33). However, no significant differences were observed in most functional or symptom scales between the two groups at 9 months postoperatively.…”

Extended Low Anterior Resection with a Circular Stapler in Patients with Rectal Cancer: a Single Center Experience

“…Several studies have determined different effective factors on rectal function post-operatively; such as female gender, residual rectal length and proximity to anal verge (Gimelfarb et al, 2013, Zbar et al, 2013. The more proximity to anal verge, the more risk of rectal dysfunction.…”

Aspectos fisiopatológicos da síndrome pós-ressecção anterior do reto para o tratamento de câncer retal

“…In spite of techniques to increase the volume of the "new rectum", such as latero-terminal anastomosis and J pouch of distal colon, the functional advantages in relation to direct anastomosis are only transient in the first 24 months 11,17,18 . Some studies suggest that intestinal dysfunction would be more related to increased colonic motility than to the type of anastomosis.…”

“…This treatment can also cause sexual and urinary dysfunctions due to nerve lesion 20,21 . Patients with LARS also present sensitivity diminishing of recto-anal transition, with prejudice to discriminate liquid and gas, affecting the rectoanal inhibitory reflex and the mechanisms of stool continence 11 . Change of rest anal pressure (internal anal sphincter -IAS) and maximum pressure of contraction (external anal sphincter -EAS) have been reported after ARR, causing soiling, and urgency and incontinence, respectively 12,14 .…”

“…The group of functional alterations of intestine following ARR is known as low anterior resection syndrome -LARS 10,11 . LARS is characterized by a combination of symptoms, that include increase of stool movements, evacuation urgency, multiple evacuations and incontinence of flatus and stool, that may negatively impact on quality of life, in special social aspects of patients submitted to ARR [11][12][13][14] . In a study about this condition, Juul et al 15 evaluated 796 patients submitted to surgical treatment of rectal cancer and showed that quality of life following surgery is closely related to the severity of LARS symptoms.…”