Ahmed Lamey
Low anterior resection syndrome (LARS) is a group of stars of side effects, for example, fecal incontinence or earnestness, visit or divided solid discharges, exhausting challenges, and expanded intestinal gas, that happen after a sphincter-saving resection (ie, front resection) of the rectum. An estimated 25 to 80 percent of patients develop LARS following a sphincter sparing rectal surgery. After a sphinctersparing rectal resection, we suggest pelvic floor muscle training with home Kegel exercises for all patients. Additionally, those who have a protective stoma that is not expected to close within one to two months should also receive daily or two- to three-times-per-week enemas or anterograde colonic irrigation via the stoma. LARS should be suspected in patients who develop one or more bowel symptoms after undergoing a sphincter-sparing resection of the rectum. The diagnosis is confirmed after the symptom(s) persist for one month after surgery and an evaluation fails to elucidate an alternative etiology. At one month after the initial surgery or after the protective stoma is closed, patients who have persistent bowel symptoms should be formally evaluated with one of the patient questionnaires such as the LARS score. Further treatment options are dependent upon the LARS score. Although anorectal/ colonic manometry is not required to diagnose LARS, it can be helpful in monitoring patient response to treatment, especially for major LARS. For patients with minor LARS (LARS score <30), we suggest medical treatment rather than more intensive or invasive modalities of therapy. For patients with major LARS (LARS score ≥30) we suggest intensive multimodal therapy including transanal irrigation and pelvic floor rehabilitation. At one year, patients who continue to have major LARS should be offered a trial of sacral nerve stimulation (SNS) in addition to continued transanal irrigation and pelvic floor rehabilitation.
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