Using transanal irrigation in the management of low anterior resection syndrome: a service audit

Using transanal irrigation in the management of low anterior resection syndrome a service audit

Review By Brigitte Collins

One of the most noticeable advancements in colorectal surgery within the last decade has been the increasing use of sphincter-preserving rectal surgery with a low colorectal or colo-anal anastomosis (Berger et al, 2016). This type of surgery avoids a permanent stoma, and the use of a temporary ileostomy is now considered to be standard practice for most colorectal surgeons in the UK (Powell-Chandler et al, 2018). 

However, such developments come with consequences, where up to 80% of patients will develop a considerable degree of bowel dysfunction, namely low anterior resection syndrome (LARS). 

Symptoms of LARS are epitomised by faecal incontinence / urgency / frequency / fragmentation / evacuation difficulties, which can have a detrimental effect on quality of life. Conservative management consists of a range of treatments including of transanal irrigation (TAI), which fits into the LARS treatment algorithm (Embleton and Henderson 2021). 

Rebecca Embleton and Michelle Henderson (2021), undertook a service audit at the Durham bowel dysfunction service, which aimed to determine whether the use of TAI improved patient outcomes. The audit concluded that TAI reduced both the frequency of bowel movements and episodes of faecal incontinence.

I always find that having valuable data such as the Durham audit, supports clinicians in developing services and generates a wider approach to treatments being offered.   

References 
Berger N et al (2016) Low anterior resection syndrome: current management and future directions. Clin Colon Rectal Surg. 29(03):239–245. 

Powell-Chandler A et al (2018) PARiS (Physiotherapy and Anterior Resection Syndrome) Trial Management Group. Physiotherapy and anterior resection syndrome (PARiS) trial: feasibility study protocol. BMJ Open. 8(6):e021855

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