Management guidelines for low anterior resection syndrome - the MANUEL project

Peter Christensen, Coen Im Baeten, Eloy Espín-Basany, Jacopo Martellucci, Karen P Nugent, Frank Zerbib, Gianluca Pellino, Harald Rosen, MANUEL Project Working Group, Peter Christensen, Coen Im Baeten, Eloy Espín-Basany, Jacopo Martellucci, Karen P Nugent, Frank Zerbib, Gianluca Pellino, Harald Rosen, MANUEL Project Working Group

Abstract

Aim: Little is known about the pathophysiology of low anterior resection syndrome (LARS), and evidence concerning the management of patients diagnosed with this condition is scarce. The aim of the LARS Expert Advisory Panel was to develop practical guidance for healthcare professionals dealing with LARS.

Method: The 'Management guidelines for low anterior resection syndrome' (MANUEL) project was promoted by a team of eight experts in the assessment and management of patients with LARS. After a face-to-face meeting, a strategy was agreed to create a comprehensive, practical guide covering all aspects that were felt to be clinically relevant. Eight themes were decided upon and working groups established. Each working group generated a draft; these were collated by another collaborator into a manuscript, after a conference call. This was circulated among the collaborators, and it was revised following the comments received. A lay patient revised the manuscript, and contributed to a section containing a patient's perspective. The manuscript was again circulated and finalized. A final teleconference was held at the end of the project.

Results: The guidance covers all aspects of LARS management, from pathophysiology, to assessment and management. Given the lack of sound evidence and the often poor quality of the studies, most of the recommendations and conclusions are based on the opinions of the experts.

Conclusions: The MANUEL project provides an up-to-date practical summary of the available evidence concerning LARS, with useful directions for healthcare professional and patients suffering from this debilitating condition.

Keywords: LARS; colorectal surgery; complications; consensus; guidance; low anterior resection syndrome; rectal surgery.

Conflict of interest statement

KPN and HR are members of the scientific board for transanal irrigation of Coloplast. CIMB served as speaker for Coloplast and Medtronic. FZ has served as consultant/speaker for Coloplast, Takeda, Allergan, Biocodex, Vifor Pharma, Mayoly Spindler, Ipsen, Abbott, Reckitt Benckiser and Alfasigma. PC is an Advisory Board member of Coloplast A/S and Wellspect Inc., and received a research grant from MBH International. The other authors have no conflicts of interest to report. The panel was offered external support by Coloplast for planning the meetings and for the organization of the work. Coloplast A/S facilitated the face‐to‐face meetings and teleconferences, but did not have any influence on the priorities of the MANUEL project and final manuscript.

© 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

Figures

FIGURE 1
FIGURE 1
Pathophysiology of low anterior resection syndrome (LARS). Schematic representation of the multifactorial aetiology of the syndrome. LARS is likely to result from a combination of several components
FIGURE 2
FIGURE 2
International consensus definition of low anterior resection syndrome (LARS). LARS is defined as one or more symptoms with one or more consequences following anterior resection [6]
FIGURE 3
FIGURE 3
A suggested treatment chart for patients with low anterior resection syndrome

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