- 期刊
Transanal Irrigation for Managing Low Anterior Resection Syndrome after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis of Controlled Trials
運用經肛門灌洗治療大腸直腸癌術後低前位切除症候群：隨機對照試驗之系統性文獻回顧與統合分析
摘要
Background: Preserving anal sphincter integrity is crucial in colorectal surgery, but patients may develop low anterior resection syndrome (LARS) with prevalence rates of 18% to 53%, impacting well-being. Evidence-supporting treatments are limited. Transanal irrigation (TAI), a minimally invasive and reversible method, employs mechanical washout or stimulates colonic movement. This study aimed to assess the effectiveness and safety of TAI in managing LARS. Methods: We systematically searched Cochrane Library, PubMed, EMBASE, Chinese Electronic Periodical Services, and ClinicalTrials.gov up to February 16, 2024, for randomized controlled trials (RCTs). Enrolled participants had undergone colorectal surgery with or without LARS, comparing TAI to standard care and posterior tibial nerve stimulation. Primary endpoints assessed bowel symptom severity and fecal incontinence, while secondary outcomes included patient satisfaction, quality of life (QoL), and adverse events (AEs). The Cochrane Risk of Bias (RoB 2.0) tool guided quality assessment, and data analysis utilized Review Manager 5.4. Results: Among the 4 studies, data from 129 patients showed significant benefits in bowel symptom severity for the TAI group at 3 to 6 months with a mean difference (MD) of -12.23 (95% confidence interval [CI], -15.63 to -8.83; I^2 = 0%), and -9.58 (95% CI, -15.30 to -3.86; I^2 = 0%), respectively. Fecal incontinence score demonstrated advantages in the TAI group at 3 to 6 months (Standardized mean difference (SMD), -3.01; 95% CI, -4.37 to -0.66; I^2 = 0%), with no significant differences after 12 months. (SMD, -2.73; 95% CI, -6.26 to -0.80; I^2 = 0%). Regarding bowel control satisfaction (MD, -0.10; 95% CI, -1.35 to 1.15; I^2 = 0%), and QoL measurement revealed no significant between-group differences. Conclusions: Transanal irrigation effectively reduces LARS symptoms, but satisfaction may vary due to individual factors like device-related discomfort. Personalized TAI treatment for a patient after colorectal surgery to enhance their quality of life.