Low Anterior Resection Syndrome

Abstract

Purpose of review: Low anterior resection syndrome is a highly prevalent condition that can develop after anal sphincter-sparing surgery for rectal cancer and impair quality of life. In this review, we summarize the major features and pathophysiology of this syndrome and discuss treatment approaches.

Recent findings: Quality of life correlates significantly with severity of low anterior resection syndrome. Prompt assessment and initiation of therapy are essential to rehabilitating damaged mechanical and neural structures. Anorectal manometry demonstrates a global decrease in sphincteric function postoperatively, though in many patients, function does recover. Transanal irrigation, pelvic floor rehabilitation, and biofeedback are the mainstays of the treatment of major LARS. Definitive stoma can be considered in therapy refractory LARS > 2 years. The development of low anterior resection syndrome likely involves an interplay between mechanical and neural pathways. Clinically, patients present at varying levels of severity, and scoring systems are available to help assess patient symptoms and guide therapy. Treatment approaches range from conservative therapies to biofeedback and sacral nerve stimulation. Future randomized controlled trials aimed at risk stratification of patients and development of severity-based treatment algorithms are warranted.

Keywords: Fecal incontinence; Internal anal sphincter; Low anterior resection syndrome; Rectal cancer; Urgency.

Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interests.

Figures

Fig. 1

a Colonic J-pouch fashioned from the sigmoid colon to form the proximal portion of the coloanal anastomosis. b End-to-end anastomosis between the sigmoid colon and the anal canal following a very low anterior resection of the rectum

Fig. 2

Treatment algorithm for low anterior resection syndrome