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Low anterior resection syndrome — Clinical Guidelines

Overview

Low anterior resection syndrome (LARS) refers to a constellation of symptoms including altered bowel function, such as increased frequency of bowel movements and incontinence, following low anterior resection of the rectum. 1

Diagnosis

Clinical symptoms include increased bowel frequency and incontinence.

No specific diagnostic tests; diagnosis is primarily clinical based on patient history and symptomatology. 1

Management

First-line treatments:

- 5-HT3 receptor antagonists (effective for reducing LARS score and bowel movements within <3 months follow-up). 1 - Pelvic floor rehabilitation (effective for reducing daily bowel movements within ≤3 months follow-up). 1

Adjunctive treatments:

- Percutaneous tibial nerve stimulation (effective for reducing LARS score between 3-6 months follow-up). 1 - Transanal irrigation (effective for reducing LARS score over 3-12 months follow-up). 1

Special Populations

No specific guidelines provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts. 1 3 8

Key Recommendations

Utilize 5-HT3 receptor antagonists as the most effective pharmacological intervention for reducing both LARS scores and daily bowel movements within the first 3 months post-surgery. (Evidence: Strong 1)

Consider pelvic floor rehabilitation for patients experiencing increased daily bowel movements, particularly within the initial 3 months post-resection. (Evidence: Moderate 1)

For patients requiring longer-term management (3-12 months), transanal irrigation should be considered due to its efficacy in reducing LARS symptoms. (Evidence: Moderate 1)

References

1 Zhou L, Zhang Z, Wang L. Treatment of anterior resection syndrome: A systematic review and network meta-analysis. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2024. link 2 Viderman D, Nabidollayeva F, Bilotta F, Abdildin YG. Comparison of dexmedetomidine and propofol for sedation in awake craniotomy: A meta-analysis. Clinical neurology and neurosurgery 2023. link 3 Bando T, Kondo K, Onishi C, Takizawa H, Imai Y, Yamada K. The Development of the Arm Fixation Method to Prevent Ipsilateral Shoulder Pain in Patients Undergoing Lung Resection. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses 2021. link 4 Ueno M, Hayami S, Sonomura T, Tanaka R, Kawai M, Hirono S et al.. Indocyanine green fluorescence imaging techniques and interventional radiology during laparoscopic anatomical liver resection (with video). Surgical endoscopy 2018. link 5 Amar D, Zhang H, Pedoto A, Desiderio DP, Shi W, Tan KS. Protective Lung Ventilation and Morbidity After Pulmonary Resection: A Propensity Score-Matched Analysis. Anesthesia and analgesia 2017. link 6 Konstantinidis IT, Mastrodomenico P, Sofocleous CT, Brown KT, Getrajdman GI, Gönen M et al.. Symptomatic Perihepatic Fluid Collections After Hepatic Resection in the Modern Era. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2016. link 7 Ard JL, Bekker AY, Doyle WK. Dexmedetomidine in awake craniotomy: a technical note. Surgical neurology 2005. link 8 Hwang YJ, Lee JW, Kim YI. Lethal hypercytokinemia following hepatic resection under pringle maneuver: a case report. Hepato-gastroenterology 2004. link 9 Arcuri MR, Perlman AL, Philippbar SA, Barkmeier JM. The effects of a maxillary speech-aid prosthesis for the combined tongue and mandibular resection patient. The Journal of prosthetic dentistry 1991. link80020-4) 10 Hood RM. Stapling techniques involving lung parenchyma. The Surgical clinics of North America 1984. link43332-3)

Low anterior resection syndrome