Feasibility Study of Transanal Irrigation Using a Colostomy Irrigation System in Patients with Low Anterior Resection Syndrome.

Abstract

BACKGROUND\nLow anterior resection syndrome has a negative impact on quality of life. Intestinal irrigation is a method of lavage consisting of a scheduled evacuation.\n\n\nOBJECTIVE\nTo evaluate functional and quality of life outcomes in patients with low anterior resection syndrome post transanal irrigation using a colostomy irrigation system.\n\n\nDESIGN\nThis was a prospective case series.\n\n\nSETTINGS\nThis study presents a single-center experience at a tertiary oncologic center in an upper middle-income country.\n\n\nPATIENTS\nPatients classified as having minor or major syndrome 12 months after operation.\n\n\nINTERVENTIONS\nTransanal irrigation was performed using an ostomy irrigation kit. Questionnaires assessing patients bowel function (low anterior resection syndrome and Wexner score) and quality of life (Short Form-36 questionnaire) were applied before and after treatment.\n\n\nMAIN OUTCOME MEASURES\nThe primary outcomes were low anterior resection syndrome score and quality of life improvement after a 12-month treatment.\n\n\nRESULTS\nOf the 22 patients included, 20 had major and two minor low anterior resection syndrome, with a median score of 39, specially high rates of incontinence for liquid stool (21; 95.5%), clustering (21; 95.5%) and urgency (17; 77.3%). All patients successfully completed the three-day training and there were no complications during the treatment. After the 12-month period the median score was 8, with 90% of the patient classified as no syndrome and great improvement in all domains of this score. The most improved quality of life sections were patient vitality (p=0.025), physical (p=0.002), social (p=0.001) and emotional aspects (p=0.001).\n\n\nLIMITATIONS\nThe small sample size and the limited follow-up period. Conclusions: This study presents a safe implementation protocol of an ostomy irrigation device for transanal irrigation. It also adds to the literature that transanal irrigation is a safe, effective and easily implemented procedure for patients with low anterior resection syndrome with a significant improvement in quality of life. See Video Abstract at http://links.lww.com/DCR/B563 .