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: Seung Mi Yeo, Gyung Mo Son
Format: Article
Language:English
Published: Ewha Womans University College of Medicine 2022-10-01
Series:The Ewha Medical Journal
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Online Access:http://www.e-emj.org/archive/view_article?pid=emj-45-4-12
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author Seung Mi Yeo
Gyung Mo Son
author_facet Seung Mi Yeo
Gyung Mo Son
author_sort Seung Mi Yeo
collection DOAJ
description 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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spelling doaj-art-2c8a94a128cf4016896864227f86efe32025-08-20T02:36:19ZengEwha Womans University College of MedicineThe Ewha Medical Journal2234-25912022-10-0145410.12771/emj.2022.e12emj-45-4-12Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current ManagementSeung Mi YeoGyung Mo SonLow 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.http://www.e-emj.org/archive/view_article?pid=emj-45-4-12low anterior resection syndromefecal incontinencerectal neoplasmsrehabilitation
spellingShingle Seung Mi Yeo
Gyung Mo Son
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
The Ewha Medical Journal
low anterior resection syndrome
fecal incontinence
rectal neoplasms
rehabilitation
title Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
title_full Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
title_fullStr Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
title_full_unstemmed Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
title_short Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
title_sort low anterior resection syndrome pathophysiology risk factors and current management
topic low anterior resection syndrome
fecal incontinence
rectal neoplasms
rehabilitation
url http://www.e-emj.org/archive/view_article?pid=emj-45-4-12
work_keys_str_mv AT seungmiyeo lowanteriorresectionsyndromepathophysiologyriskfactorsandcurrentmanagement
AT gyungmoson lowanteriorresectionsyndromepathophysiologyriskfactorsandcurrentmanagement