Systematic review and meta-analysis of randomized clinical trials on the treatment of low anterior resection syndrome

• Published in: Surgery 2023-06, Vol.173 (6), p.1352-1358
• Main Authors: Emile, Sameh Hany, Garoufalia, Zoe, Barsom, Samer, Horesh, Nir, Gefen, Rachel, Zhou, Peige, Wexner, Steven D.
• Format: Article
• Language: English
• Subjects: Humans; Low Anterior Resection Syndrome; Postoperative Complications - etiology; Postoperative Complications - therapy; Randomized Controlled Trials as Topic; Rectal Neoplasms
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2023.02.010

We conducted a systematic review of randomized clinical trials on treating low anterior resection syndrome to help inform current practice. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses–compliant systematic review of randomized clinical trials involved different treatments for low anterior resection syndrome. The risk of bias 2 tool was used to assess the risk of bias. The main outcomes were improvement in low anterior resection syndrome after treatment assessed by change in low anterior resection syndrome, fecal incontinence scores, and adverse treatment effects. After an initial screening of 1,286 studies, 7 randomized clinical trials were included. Sample sizes ranged between 12 to 104 patients. Posterior tibial nerve stimulation was the most frequently assessed treatment in 3 randomized clinical trials. The weighted mean difference between posterior tibial nerve stimulation and medical treatment or sham therapy in follow-up low anterior resection syndrome score (–3.31, P = .157) was insignificant. Transanal irrigation reduced major low anterior resection syndrome symptoms by 61.5% compared with 28.6% after posterior tibial nerve stimulation with a significantly lower 6-month follow-up low anterior resection syndrome score. Pelvic floor training achieved better improvement in low anterior resection syndrome than standard care (47.8% vs 21.3%) at 6 months, but this was not maintained at 12 months (40.0% vs 34.9%). Ramosetron was associated with a greater short-term improvement in major low anterior resection syndrome (23% vs 8%) and a lower low anterior resection syndrome score (29.5 vs 34.6) at 4-weeks follow-up than Kegels or Sitz baths. No significant improvement in bowel function was noted after probiotics use as probiotics and placebo had similar follow-up low anterior resection syndrome scores (33.3 vs 36). Transanal irrigation was associated with improvement in low anterior resection syndrome according to 2 trials, and ramosetron showed promising short-term results in one trial. Posterior tibial nerve stimulation had a marginal benefit compared with standard care. In contrast, pelvic floor training was associated with short-term symptomatic improvement, and probiotics showed no tangible improvement in low anterior resection syndrome symptoms. Firm conclusions cannot be drawn due to the small number of trials published.