Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34679
Title: Preventative strategies for low anterior resection syndrome.
Austin Authors: Brock, H;Lambrineas, L;Ong, H I;Chen, W Y;Das, A;Edsell, A;Proud, D;Carrington, E;Smart, P;Mohan, H;Burgess, A
Affiliation: Surgery
Department of Colorectal Surgery, Austin Health, Melbourne, Australia.
Surgery (University of Melbourne)
St. Marys, Imperial College London, London, UK.
Department of Colorectal Surgery, Austin Health, Melbourne, Australia.
Issue Date: 13-Dec-2023
Date: 2023
Publication information: Techniques in Coloproctology 2023-12-13; 28(1)
Abstract: A common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly understood and challenging to treat. Despite this, prevention strategies are commonly overlooked. Our aim was to review the pathophysiology of LARS and explore current evidence on the efficacy and feasibility of prophylactic techniques. A literature review was performed between [1st January 2000 to 1st October 2023] for studies which investigated preventative interventions for LARS. Mechanisms by which LARS develop are described, followed by a review of prophylactic strategies to prevent LARS. Medline, Cochrane, and PubMed databases were searched, 189 articles screened, 8 duplicates removed and 18 studies reviewed. Colonic dysmotility, anal sphincter dysfunction and neorectal dysfunction all contribute to the development of LARS, with the complex mechanism of defecation interrupted by surgery. Transanal irrigationĀ (TAI) and pelvic floor rehabilitation (PFR) have shown benefits in preventing LARS, but may be limited by patient compliance. Intraoperative nerve monitoring (IONM) and robotic-assisted surgery have shown some promise in surgically preventing LARS. Nerve stimulation and other novel strategies currently used in treatment of LARS have yet to be investigated in their roles prophylactically. To date, there is a limited evidence base for all preventative strategies including IONM, RAS, PFP and TAI. These strategies are limited by either access (IONM, RAS and PFP) or acceptability (PFP and TAI), which are both key to the success of any intervention. The results of ongoing trials will serve to assess acceptability, while technological advancement may improve access to some of the aforementioned strategies.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34679
DOI: 10.1007/s10151-023-02872-5
ORCID: 0000-0002-7347-9863
Journal: Techniques in Coloproctology
Start page: 10
PubMed URL: 38091118
ISSN: 1128-045X
Type: Journal Article
Subjects: Low anterior resection syndrome
Prevention
Rectal cancer
Rectal Neoplasms/surgery
Rectal Neoplasms/complications
Postoperative Complications/etiology
Postoperative Complications/prevention & control
Robotic Surgical Procedures/adverse effects
Anal Canal/surgery
Appears in Collections:Journal articles

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