Fonseca GFR, Jiménez BB, Villanueva HJA

Language: Spanish
References: 21
Page: 237-242
PDF size: 68.34 Kb.

ABSTRACT

Objective: To assess the degree of severity of the low anterior resection syndrome (LARS) in patients after sphincter preserving surgery (SPS).
Setting: Coloproctology unit of the General Hospital of Mexico “Dr. Eduardo Liceaga” (Third level health care hospital).
Design: Cross-sectional cohort descriptive study.
Statistical analysis: Percentages as summary measure for qualitative variables.
Patients and methods: The study included 20 patients subjected to sphincter preserving surgery, from January 2007 to December 2011. These patients were evaluated according to the five-parameter LARS scale of the Aarhus University Hospital, in Denmark. We assessed prevalence of low anterior resection syndrome, intensity based on time and distance of the tumor from the anal margin.
Results: Of the patients, 60% coursed with the low anterior resection syndrome with an average follow-up of 20 months. Incontinence to liquids was present in 48%, fragmented defecation in 21%, urgency to defecate in 17%; the other two assessed parameters were practically inexistent. The most severe degree of low anterior resection syndrome was seen in the first 8 months after surgery and only one patient, after 24 months of the surgery, continued with severe symptoms. Patients with tumors between 7 and 10 cm from the anal margin did not develop the assessed alterations or they were very mild. All patients with a tumor at less than 7 cm developed severe alterations.
Conclusion: The most frequently found alterations were fecal incontinence to liquids, fragmented defecation, and urgency to defecate. The alterations assessed by the LARS scale were severe during the first months after surgery and when the tumor was closer to the anal margin.

REFERENCES

1. de Miguel M, Armendariz P, Ortiz H. Función defecatoria y calidad de vida con la cirugía preservadora de esfínteres en el cáncer de recto. Cir Esp 2003; 73: 52-57.

2. Rao GN, Drew PJ, Lee PW, Monson JR, Duthie GS. Anterior resection syndrome is secondary to sympathetic denervation. Int J Colorectal Dis 1996; 11: 250-258.

3. Williamson ME, Lewis WG, Holsworth PJ, Finan PJ, Johnston D. Decrease in the anorectal pressure gradient after low anterior resection of the rectum. A study using continuous ambulatory manometry. Dis Colon Rectum 1994; 37: 1228-1231.

4. Ho YH, Tsang C, Tang CL, Nyam D, Eu KW, Seow-Choen F. Anal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anrorectal manometry. Dis Colon Rectum 2000; 43: 169-173.

5. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 2012; 255: 922-928.

6. Kakodkar R, Gupta S, Nundy S. Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome. Colorectal Dis 2006; 8: 650-656.

7. Nakahara S, Itoh H, Mibu R, Ikeda S, Oohata Y, Kitano K, et al. Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA stapler for rectal cancer. Dis Colon Rectum 1988; 31: 762-766.

8. Kasparek MS, Hassan I, Cima RR, Larson DR, Gullerud RE, Wolff BG. Quality of life after coloanal anastomosis and abdominoperineal resection for distal rectal cancers: sphincter preservation vs quality of life. Colorectal Dis 2011; 13: 872-877.

9. Madoff RD, Parker SC, Varma MG, Lowry AC. Faecal incontinence in adults. Lancet 2004; 364: 621-632.

10. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351: 1731-1740.

11. Canda AE, Terzi C, Gorken IB, Oztop I, Sokmen S, Fuzun M. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Colorectal Dis 2010; 25: 197-204.

12. Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev 2008; (2): CD006040. doi: 10.1002/14651858.CD006040.pub2.

13. Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med 1984; 310: 1282-1287.

14. Rosen H, Robert-Yap J, Tentschert G, Lechner M, Roche B. Transanal irrigation improves quality of life in patients with low anterior resection syndrome. Colorectal Dis 2011; 13: e335-338.

15. Kim KH, Yu CS, Yoon YS, Yoon SN, Lim SB, Kim JC. Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery. Dis Colon Rectum 2011; 54: 1107-1113.

16. Norton C, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2006; 19: CD002111.

17. Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 2003; 125: 1320-1329.

18. Byrne CM, Solomon MJ, Young JM, Rex J, Merlino CL. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 2007; 50: 417-427.

19. Rao SS, Enck P, Loening-Baucke V. Biofeedback therapy for defecation disorders. Dig Dis 1997; 15: 78-92.

20. Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead WE. Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum 2001; 44: 728-736.

21. Whitehead WE, Burgio KL, Engel BT. Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc 1985; 33: 320-324.