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Session: ePoster: Colon and Colorectal Cancer 8 (Sun350)

EP561 - Efficacy and Safety of Transanal Irrigation in the Treatment of Low Anterior Resection Syndrome: A Systematic Review and Meta-analysis

Sunday, May 11, 2025
4:28 PM – 4:33 PM PT
Location: Monitor 3, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Sameh H. Emile, MBBCh, MSc, MD, FACS

    Project Scientist
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Plantation , FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

    • Author(s)

  • MO

    Marcus Oostenbrug, MD

    Clinical Associate
    Cleveland Clinic Florida
    Weston, Florida, United States

    Disclosure information not submitted.

  • IG

    Ilana Grosman Setton, MD

    General Surgery Resident
    Cleveland Clinic Florida
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Steven D. Wexner, MD, PhD (Hon), MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE

    Emeritus Chair, Department of Colorectal Surgery
    Cleveland Clinic Florida
    Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

    • Senior Author(s)

  • Marylise Boutros, MD (she/her/hers)

    Colorectal Surgeon
    Cleveland Clinic Florida
    McGill University
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Sameh H. Emile, MBBCh, MSc, MD, FACS: This individual has no relevant relationships with ineligible companies.
Ilana Grosman Setton, MD: This individual has no financial relationships with ineligible companies.
Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE, MD, PhD (Hon): This individual has no relevant relationships with ineligible companies.
Marylise Boutros, MD: This individual has no relevant relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Low anterior resection syndrome (LARS), a bowel dysfunction that occurs after restorative proctectomy, is often challenging to treat. Although transanal irrigation (TAI) is used for the treatment of LARS, there is scarce literature on its efficacy. The present study aimed to assess the overall efficacy and safety of TAI in the treatment of LARS

Methods/Interventions: This was a PRISMA 2020-compliant systematic review with a meta-analysis on patients with LARS after rectal resection who were treated with TAI. Proportional meta-analyses of the outcomes of TAI were performed using the random-effect model. The main outcomes included the efficacy of TAI, measured by pooled rates of improvement in LARS after TAI, and by the weighted reduction in LARS and incontinence scores as well as safety assessed by the pooled rate of complications after TAI.

Results/Outcomes: Nine studies, published between 2011 and 2024 with a total of 282 patients, were included. Three studies were randomized controlled trials and six were observational studies. The median age of patients was 65 years and 60.8% were male. The median duration of LARS symptoms was 24.2 months and the median follow-up was 9 (range, 3-39) months. The pooled rates of improvement in overall LARS and major LARS after TAI were 65.8% (95%CI: 47.4-84.2%) and 85.7% (95%CI: 74.6-96.8%), respectively. TAI was associated with a weighted mean reduction of the LARS score by 20.04 points (95%CI: 13.9- 26.2, p< 0.001) and the Cleveland
Clinic Florida/Wexner incontinence score by 7.4 points (95%CI: 2.4-12.3, p=0.004) (Figure). The pooled rate of complications with TAI was 30.9% (95%CI:10- 60.8%) and most complications consisted of minor rectal bleeding and transient abdominal pain. No cases of rectal perforation were recorded. Meta-regression analysis showed that the efficacy of TAI was increased in male patients when a diverting stoma was used at the index operation, and it was reduced with a longer duration of LARS symptoms before initiation of TAI.

Conclusion/Discussion: TAI is likely safe and effective in the treatment of LARS; however, the current results reflect short-term outcomes from mainly observational data. Larger well controlled studies would be helpful to better clarify the safety and efficacy of TAI.