Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Low anterior resection syndrome (LARS) is a condition of anorectal dysfunction that occurs frequently following anal sphincter-preserving surgery for rectal cancer and can reduce the quality of life. In this review, we summarize the main sy...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Ewha Womans University College of Medicine
2022-10-01
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| Series: | The Ewha Medical Journal |
| Subjects: | |
| Online Access: | http://www.e-emj.org/archive/view_article?pid=emj-45-4-12 |
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| Summary: | Low anterior resection syndrome (LARS) is a condition of anorectal dysfunction
that occurs frequently following anal sphincter-preserving surgery for rectal
cancer and can reduce the quality of life. In this review, we summarize the main
symptoms and pathophysiology of this syndrome and discuss the treatment
approaches. Early evaluation and initiation of appropriate treatment
postoperatively are crucial. The most frequently used tool to evaluate the
severity of LARS is the LARS score, and an anorectal manometer is used for
objective evaluation. LARS is believed to be caused by multiple factors, and
some of its causes include direct structural damage to the anal sphincter,
damage to the innervation, loss of rectoanal inhibitory reflex, and decreased
rectal volume and compliance. Diet modifications, medications, pelvic floor
muscle training and biofeedback are the primary treatments, and rectal
irrigation can be added as a secondary treatment. If LARS symptoms persist even
after 1 to 2 years and significantly reduce the quality of life, antegrade
irrigation, sacral nerve stimulation or definitive stoma may be considered.
High-quality evidence-based studies on LARS treatment are lacking, and
randomized controlled trials aimed at developing severity-based treatment
algorithms are needed. |
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| ISSN: | 2234-2591 |