Anterior Resection Syndrome

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Postoperative defecation dysfunctions known as "anterior resection syndrome" may occur following TME.

Straight colorectal anastomosis (SCA), colon J-pouch (CJP), and side-to-end anastomosis are all frequently used techniques for reconstruction (SEA) There are no prospective, multicenter, randomized trials comparing their functional outcomes, including long-term evaluations.

As a result, the primary endpoint of a study designed by Marti and colleagues included a comparison of composite evacuation scores 12 months after TME.

Secondary endpoints included a comparison of composite evacuation and incontinence ratings at six, eight, eighteen, and twenty-four months following surgery, as well as morbidity and overall survival.

The study compared the "per protocol" (PP) population to the "intention-to-treat" (ITT) population.

There were no statistically significant differences in the composite evacuation ratings of the PP and ITT populations at any time point.

Similarly, there was no statistically significant difference in composite incontinence scores between the PP and ITT populations at any time point when the three trial weapons were compared.

Conclusions: During the course of the investigation, surgeons in charge may continue to perform intestinal continuity reconstruction at their discretion following TME.

Along with the previous studies, Hou and colleagues investigated whether the use of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is problematic and conducted a meta-analysis to compare the safety and efficacy of SEA to colonic J-pouch (CJP) anastomosis, which has been shown to improve postoperative bowel function.

The meta-analysis included 864 patients from ten randomized controlled trials.

At 12 months after SPR, patients who underwent SEA had a higher frequency of defecation and a lower rate of incomplete defecation than those who underwent CJP anastomosis with low heterogeneity and a lower rate of incomplete defecation at 3 months.

Additionally, the SEA group operated for a shorter period of time with little heterogeneity.

Although the SEA group had a significantly greater anorectal resting strain, there was considerable heterogeneity.

There were no significant differences between the groups in terms of efficacy outcomes such as frequency of defecation, urgency, incomplete defecation, use of pads, enema, medications, anorectal squeeze pressure, and maximum rectal volume, or in terms of safety outcomes such as operating time, blood loss, use of protective stoma, postoperative complications, clinical outcomes, and complication rates.

In comparison to CJP anastomosis, the available evidence indicates that SEA is a successful anastomotic technique that results in comparable postoperative bowel function without increasing the risk of complications.

SEA has several advantages, including shorter operating times, a lower rate of incomplete defecation three months after surgery, and improved sphincter function.

However, following SPR, the frequency of defecation should be closely monitored over the long term.

References

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