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Techniques in Coloproctology
Published in: Techniques in Coloproctology 7/2018

01-07-2018 | Original Article

Role of transanal irrigation in the treatment of anterior resection syndrome

Authors: J. Martellucci, A. Sturiale, C. Bergamini, L. Boni, F. Cianchi, A. Coratti, A. Valeri

Published in: Techniques in Coloproctology | Issue 7/2018

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Abstract

Background

Transanal irrigation(TAI) has been reported to be an inexpensive and effective treatment for low anterior resection syndrome(LARS). The aim of the present prospective study was to evaluate the use of TAI in patients with significant LARS symptoms at a single medical center.

Methods

Patients who had low anterior resection for rectal cancer between April 2015 and May 2016 at the Careggi University Hospital were assessed for LARS using the LARS and the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (MSKCC BFI) questionnaires 30–40 days after  surgery or ileostomy closure (if this was done). Quality of life was evaluated using a visual analog scale and the Short Form-36 Health Survey. All patients with LARS score of 30 or higher were included (early LARS) as were all patients with a LARS score of 30 or higher referred 6 months or longer after surgery performed elsewhere (chronic LARS) in the same study period. Study participants were trained to perform TAI using the Peristeen™ System for 6 months, followed by 3 months of enema therapy following a similar protocol.

Results

Thirty-three patients were enrolled in the study. Six patients stopped the treatment. The 27 patients (19 early LARS and 8 chronic LARS) who completed the study had a significant decrease in the number of median daily bowel movements [baseline 7 (range 0–14); 6 months 1 (range 0–4); 9 months 4 (range 0–13)]. The median LARS Score fell from 35.1 (range 30–42) (baseline) to 12.2 (range 0–21) after 6 months (p < 0.0001) and then rose to 27 (range 5–39) after 3 months of enema therapy. There was no difference in LARS score decrease at 6 months between the patients with early and chronic LARS (22.5 and 23.9 respectively; p=0.7) and there were no predictors of score decrease. Four components of the SF-36 significantly improved during the TAI period. The MSKCC BFI score significantly improved in several domains. Twenty-three patients (85%) asked to continue the treatment with TAI after the study ended.

Conclusions

TAI appears to be an effective treatment for LARS and results in a marked improvement of continence and quality of life.  Patients may be assessed and treated for LARS early after surgery since the treatment benefit is similar to that observed in patients with LARS diagnosed  6 months or longer after surgery. The potential rehabilitative role of TAI for LARS is promising and should be further investigated.
Literature
1.
Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL (2012) Anterior resection syndrome. Lancet Oncol 13:e403–e408CrossRefPubMed
2.
Sturiale A, Martellucci J, Zurli L, Vaccaro C, Brusciano L, Limongelli P, Docimo L, Valeri A (2017) Long-term functional follow-up after anterior rectal resection for cancer. Int J Colorectal Dis 32:83–88CrossRefPubMed
3.
Chen TY, Wiltink LM, Nout RA, Meershoek-Klein Kranenbarg E, Laurberg S, Marijnen CA, van de Velde CJ (2015) Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer 14:106–114CrossRefPubMed
4.
Rosen H, Robert-Yap J, Tentschert G, Lechner M, Roche B (2011) Transanal irrigation improves quality of life in patients with low anterior resection syndrome. Colorectal Dis 13:e335–e338CrossRefPubMed
5.
Koch SM, Rietveld MP, Govaert B, van Gemert WG, Baeten CG (2009) Retrograde colonic irrigation for faecal incontinence after low anterior resection. Int J Colorectal Dis 24:1019–1022CrossRefPubMed
6.
Martellucci J (2016) Low anterior resection syndrome: a treatment algorithm. Dis Colon Rectum 59:79–82CrossRefPubMed
7.
Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, Guillem JG, Minsky BD, Kalman M, Thaler HT, Schrag D, Wong WD (2005) The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 48:1353–1365CrossRefPubMed
8.
Zotti P, Del BP, Serpentini S, Trevisanut P, Barba MC, Valentini V, De Paoli A, Pucciarelli S (2011) Validity and reliability of the MSKCC bowel function instrument in a sample of Italian rectal cancer patients. Eur J Surg Oncol 37:589–596CrossRefPubMed
9.
Emmertsen KJ, Laurberg S (2012) 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 255:922–928CrossRefPubMed
10.
Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305(6846):160–164CrossRefPubMedPubMedCentral
11.
Gosselink MP, Darby M, Zimmerman DD, Smits AA, van Kessel I, Hop WC, Briel JW, Schouten WR (2005) Long-term follow-up of retrograde colonic irrigation for defaecation disturbances. Colorectal Dis 7:65–69CrossRefPubMed
12.
Christensen P, Krogh K, Buntzen S, Payandeh F, Laurberg S (2009) Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence. Dis Colon Rectum 52:286–292CrossRefPubMed
13.
Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, Media S, Laurberg S (2006) A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 131:738–747CrossRefPubMed
14.
Coggrave M, Norton C, Cody JD (2014) Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev 1:CD002115
15.
Koch SM, Uludağ O, El Naggar K, van Gemert WG, Baeten CG (2008) Colonic irrigation for defecation disorders after dynamic graciloplasty. Int J Colorectal Dis 23:195–200CrossRefPubMed
16.
O’Bichere A, Sibbons P, Doré C, Green C, Phillips RK (2000) Experimental study of faecal continence and colostomy irrigation. Br J Surg 87:902–908CrossRefPubMed
17.
Gattuso JM, Kamm MA, Myers C, Saunders B, Roy A (1996) Effect of different infusion regimens on colonic motility and efficacy of colostomy irrigation. Br J Surg 83:1459–1462CrossRefPubMed
18.
Yasuda S, Fujii H, Yamamoto K, Nakagawa M, Watanabe I, Nakano H (1992) A scintigraphic analysis of colonic movement in patients with colostomy: changes of colonic transit time after acquaintance with irrigation. Surg Today 22:386–389CrossRefPubMed
19.
20.
Pucciani F, Ringressi MN, Redditi S, Masi A, Giani I (2008) Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results. Dis Colon Rectum 51:1552–1558CrossRefPubMed
21.
Visser WS, Te Riele WW, Boerma D, van Ramshorst B, van Westreenen HL (2014) Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Ann Coloproctol 30:109–114CrossRefPubMedPubMedCentral
22.
Ramage L, Qiu S, Kontovounisios C, Tekkis P, Rasheed S, Tan E (2015) A systematic review of sacral nerve stimulation for low anterior resection syndrome. Colorectal Dis 17:762–771CrossRefPubMed
23.
24.
Vigorita V, Rausei S, Troncoso Pereira P, Trostchansky I, Ruano Poblador A, Moncada Iribarren E, Facal Alvarez C, de San Ildefonso Pereira A, Casal Nunez E (2017) A pilot study assessing the efficacy of posterior tibial nerve stimulation in the treatment of low anterior resection syndrome. Tech Coloproctol 21:287–293. https://​doi.​org/​10.​1007/​s10151-017-1608-x CrossRefPubMed
25.
Auwerda JJ, Bac DJ, Schouten WR (2001) Circadian rhythm of rectal motor complexes. Dis Colon Rectum 44:1328–1332CrossRefPubMed
26.
Hagger R, Kumar D, Benson M, Grundy A (2002) Periodic colonic motor activity identified by 24-h pancolonic ambulatory manometry in humans. Neurogastroenterol Motil 14:271–278CrossRefPubMed
27.
Rao SS, Welcher K (1996) Periodic rectal motor activity: the intrinsic colonic gatekeeper? Am J Gastroenterol 91:890–897PubMed
28.
29.
Chen TY, Emmertsen KJ, Laurberg S (2014) Bowel dysfunction after rectal cancer treatment: a study comparing the specialist’s versus patient’s perspective. BMJ Open 4:e003374CrossRefPubMedPubMedCentral
30.
Chen TY, Emmertsen KJ, Laurberg S (2015) What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Curr Colorectal Cancer Rep 11:37–43CrossRefPubMed
31.
Christensen P, Krogh K, Perrouin-Verbe B, Leder D, Bazzocchi G, Petersen Jakobsen B, Emmanuel AV (2016) Global audit on bowel perforations related to transanal irrigation. Tech Coloproctol 20:109–115CrossRefPubMed
32.
Memon S, Bissett IP (2016) Rectal perforation following transanal irrigation. ANZ J Surg 86:412–413CrossRefPubMed
33.
Emmanuel AV, Krogh K, Bazzocchi G, Leroi AM, Bremers A, Leder D, van Kuppevelt D, Mosiello G, Vogel M, Perrouin-Verbe B, Coggrave M, Christensen P; Members of working group on Trans Anal Irrigation from UK, Denmark, Italy, Germany, France and Netherlands (2013) Consensus review of best practice of transanal irrigation in adults. Spinal Cord. 51:732–738CrossRefPubMed
34.
Atkin WS, Cook CF, Cuzick J, Edwards R, Northover JM, Wardle J; UK Flexible Sigmoidoscopy Screening Trial Investigators (2002) Single flexible Sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet 359(9314):1291–1300CrossRefPubMed
35.
Loffeld RJ, Engel A, Dekkers PE (2011) Incidence and causes of colonoscopic perforations: a single-center case series. Endoscopy 43:240–242CrossRefPubMed
36.
Gedebou TM, Wong RA, Rappaport WD, Jaffe P, Kahsai D, Hunter GC (1996) Clinical presentation and management of iatrogenic colon perforations. Am J Surg 172:454–457CrossRefPubMed
37.
Hamonet-Torny J, Bordes J, Daviet JC, Dalmay F, Joslin F, Salle JY (2013) Long-term transanal irrigation’s continuation at home. Preliminary study. Ann Phys Rehabil Med 56:134–142CrossRefPubMed
Metadata
Title
Role of transanal irrigation in the treatment of anterior resection syndrome
Authors
J. Martellucci
A. Sturiale
C. Bergamini
L. Boni
F. Cianchi
A. Coratti
A. Valeri
Publication date
01-07-2018
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 7/2018
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-018-1829-7

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