Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations

• Published in: Techniques in coloproctology Vol. 17; no. 2; pp. 151 - 162
• Main Authors: Ziv, Y., Zbar, A., Bar-Shavit, Y., Igov, I.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.04.2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Colonic Neoplasms - surgery; Colonic Pouches; Colorectal Surgery; Digestive System Surgical Procedures - adverse effects; Fecal Incontinence - epidemiology; Fecal Incontinence - physiopathology; Flatulence - epidemiology; Gastroenterology; Humans; Medicine; Medicine & Public Health; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Proctology; Reconstructive Surgical Procedures; Recovery of Function; Rectal Neoplasms - surgery; Review; Surgery; Syndrome; Fecal incontinence; Anterior resection syndrome; Soiling
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-012-0909-3

Between 25 and 80 % of patients undergoing a low or very low anterior resection will suffer postoperatively, from a constellation of symptoms including fecal urgency, frequent bowel movements, bowel fragmentation and incontinence, collectively referred to as the low anterior resection syndrome (LARS). The etiology of LARS is multifactorial with the potential of sphincter injury during anastomosis construction, alterations in anorectal physiology, the development of a pudendal neuropathy, and a lumbar plexopathy with exacerbation of symptoms if there is associated anastomotic sepsis or the use of adjuvant and neoadjuavnt therapies. The symptoms of LARS may be obviated in part by the construction of a neorectal reservoir which may take the form of a colonic J-pouch, a transverse coloplasty, or a side-to-end anastomosis. This review outlines the factors contributing to LARS symptomatology along with the short- and medium-term functional results of comparative trials with the different types of neorectal reconstructions.