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Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer.
Chin Med J (Engl). 2020 Aug 05; 133(15):1824-1833.CM

Abstract

Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

Authors+Show Affiliations

Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea. Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura 35511, Egypt.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea. Department of General Surgery, King Faisal University, Alahsa 31982, Saudi Arabia.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea. Department of General Surgery, Main hospital, Assiut Faculty of Medicine, Assiut University, Assiut 71511, Egypt.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32604174

Citation

Sakr, Ahmad, et al. "Assessment and Management of Low Anterior Resection Syndrome After Sphincter Preserving Surgery for Rectal Cancer." Chinese Medical Journal, vol. 133, no. 15, 2020, pp. 1824-1833.
Sakr A, Sauri F, Alessa M, et al. Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer. Chin Med J. 2020;133(15):1824-1833.
Sakr, A., Sauri, F., Alessa, M., Zakarnah, E., Alawfi, H., Torky, R., Kim, H. S., Yang, S. Y., & Kim, N. K. (2020). Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer. Chinese Medical Journal, 133(15), 1824-1833. https://doi.org/10.1097/CM9.0000000000000852
Sakr A, et al. Assessment and Management of Low Anterior Resection Syndrome After Sphincter Preserving Surgery for Rectal Cancer. Chin Med J. 2020 Aug 5;133(15):1824-1833. PubMed PMID: 32604174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer. AU - Sakr,Ahmad, AU - Sauri,Fozan, AU - Alessa,Mohammed, AU - Zakarnah,Eman, AU - Alawfi,Homoud, AU - Torky,Radwan, AU - Kim,Ho Seung, AU - Yang,Seung Yoon, AU - Kim,Nam Kyu, PY - 2020/7/1/pubmed PY - 2020/7/1/medline PY - 2020/7/1/entrez SP - 1824 EP - 1833 JF - Chinese medical journal JO - Chin. Med. J. VL - 133 IS - 15 N2 - Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS. SN - 2542-5641 UR - https://www.unboundmedicine.com/medline/citation/32604174/Assessment_and_management_of_low_anterior_resection_syndrome_after_sphincter_preserving_surgery_for_rectal_cancer L2 - https://doi.org/10.1097/CM9.0000000000000852 DB - PRIME DP - Unbound Medicine ER -
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