Long-term outcomes of transanal irrigation in patients with low anterior resection syndrome: what happens after more than five years?

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Abstract
Low anterior resection syndrome (LARS) significantly impacts quality of life after rectal cancer surgery. Transanal irrigation (TAI) is a potential treatment, but long-term outcome data are limited. This study aims to evaluate the efficacy and safety of TAI in LARS patients after more than 5 years of follow-up. From April 2015 to December 2019, consecutive patients with LARS following low anterior resection for rectal cancer, trained in TAI at Careggi University Hospital, were prospectively collected. Patients with LARS scores > 30 or those failing conservative management were included. TAI was performed using the Peristeen® device, with a standard protocol of 400-600 ml irrigation 3-4 times/week. Primary outcomes were maintenance of TAI benefits and patient satisfaction (VAS). After an appropriate training and evaluation period, 35 patients were referred to TAI. While interruptions in the first year were mainly related to technical problems, ineffectiveness, or the onset of other clinical problems, afterward, patients tended to discontinue treatment only in the event of death (6 patients) or clinical well-being (5 patients). At the last follow-up control, with a median follow-up of 89 months, 15 patients (43%) still used TAI treatment. The median VAS satisfaction score for bowel control was 8.2. TAI demonstrates sustained benefits in LARS patients over 5 years, with significant symptom improvement and high patient satisfaction. Further studies are needed to identify predictors of long-term success.

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