Sacral nerve stimulation can be an effective treatment for low anterior resection syndrome

Eftaiha, Saleh M.; Balachandran, Banujan; Marecik, Sławomir; Mellgren, Anders; Nordenstam, Johan; Melich, George; Prasad, Leela M.; Park, John J.

doi:10.1111/codi.13701

Cited by 33 publications

(30 citation statements)

References 25 publications

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“…As these patients have altered anatomy after resection of the rectum, it is unclear how much benefit SNM may play in achieving relief of symptoms. Two separate studies were conducted on the utility of SNS in LARS . Success was noted in 47‐100% of patients subjected to a test implantation and QOL was generally improved .…”

Section: Fecal Incontinence (Fi)mentioning

confidence: 99%

International Continence Society best practice statement for use of sacral neuromodulation

Goldman

Lloyd

Noblett

et al. 2018

Neurourology and Urodynamics

138

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Section: Fecal Incontinence (Fi)mentioning

confidence: 99%

International Continence Society best practice statement for use of sacral neuromodulation

Goldman

Lloyd

Noblett

et al. 2018

Neurourology and Urodynamics

138

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“…Table summarizes the details of PNE and SNS implantation. In seven studies, a two‐staged procedure was performed with permanent SNS implantation after a satisfactory PNE test phase using temporary electrodes . A three‐staged procedure was performed in three studies .…”

Section: Resultsmentioning

confidence: 99%

“…Two analyses were conducted, based on outcomes as assessed using the CCIS and the LARS score. A meta‐analysis was conducted by using seven studies . Three studies were excluded from forest plots due to incomplete information and study design (case report) .…”

Section: Resultsmentioning

confidence: 99%

“…The current review found the overall median improvement in SNS score post treatment to be 67% which is considerably lower than that in the Ramage et al . study because of the inclusion of two additional studies which had 12 and 15 patients respectively . Although numbers remain relatively small, the inclusion of these two studies increased overall patient numbers by 32%.…”

Section: Discussionmentioning

confidence: 99%

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Sacral nerve stimulation for bowel dysfunction following low anterior resection: a systematic review and meta‐analysis

Huang

Koh

2019

Colorectal Disease

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Aim Low anterior resection syndrome (LARS) can affect up to 70% of all patients with rectal cancer. In the last two decades, sacral nerve stimulation (SNS) has emerged as an effective treatment for faecal incontinence. There is some encouraging literature on the use of SNS in patients with LARS. The purpose of this review is to provide an up to date review on the utility of SNS on LARS. Method A literature search was conducted using the MEDLINE, Embase and PubMed databases (January 1981–March 2019). Studies identified were appraised with standard selection criteria. Data points were extracted, and meta‐analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Results Ten studies met the inclusion criteria and were included in this study. All studies used the Cleveland Clinic Incontinence Score (CCIS), whereas the low anterior resection syndrome score (LARS score) was used in three studies. Overall median improvement in the scoring system was 67.0% (range 35.5%–88.2%) after SNS implantation. There was a significant reduction in CCIS after SNS implantation (mean difference 11.23, 95% confidence interval 9.38–13.07, Z = 11.90, P < 0.00001). The LARS score was also significantly reduced after using SNS in patients with LARS (mean difference 17.87, 95% confidence interval 10.15–25.59, Z = 4.54, P < 0.00001). Conclusion Use of SNS may provide symptomatic benefits for patients with LARS refractory to medical therapy. However, the current level of evidence remains limited. A large multicentre study of SNS for LARS using the validated LARS score is warranted. In addition, the cost‐effectiveness of SNS for patients with LARS needs further exploration.

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“…A literature review found good outcomes with SNS in 74% of cases, although these studies used different scales to assess symptoms and lacked a standardized instrument to assess ARS. A recent study on the efficacy of SNS for ARS in 10 patients , using the LARS scale, observed a reduction in severity from baseline, with scores falling from 34 to 21.6 after 19.5 months of follow‐up; in 80% of patients there was a reduction in LARS category from ‘major LARS’ to ‘minor LARS’ or ‘no LARS’. These data suggest that SNS could be an effective alternative to TAI in patients with severe ARS who find TAI difficult to manage.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2019

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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.

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Sacral nerve stimulation can be an effective treatment for low anterior resection syndrome

Abstract: Sacral nerve stimulation improved symptoms in patients suffering from low anterior resection syndrome and may therefore be a viable treatment option.

Cited by 33 publications

References 25 publications

International Continence Society best practice statement for use of sacral neuromodulation

International Continence Society best practice statement for use of sacral neuromodulation

Sacral nerve stimulation for bowel dysfunction following low anterior resection: a systematic review and meta‐analysis

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

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