TREATMENT OPTIONS FOR PATIENTS WITH LOW ANTERIOR RESECTION SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS
Mohamed Hammad*1, Yasra Badi2, Mujtaba Mohamed1, Abdelwahap Elghezewi1, Abdulrahman I. Hagrass3, Ahmed H. Fathallah4, Khaled M. Ragab4, Anas Z. Nourelden3, Mohamed Sultan5
1Marshall University Joan C Edwards School of Medicine, Huntington, WV; 2All Saints University School of Medicine, Roseau, Saint George, Dominica; 3Al-Azhar University Faculty of Medicine, Cairo, Egypt; 4Minia University Faculty of Medicine, Minia, Egypt; 5MedStar Georgetown University Hospital, Washington,
Aim: To condense and outline the different proofs previously published in the literature, comparing the array of treatments and interventions currently available to manage Low Anterior Resection Syndrome (LARS) while trying to determine the optimum treatment method, thereby aiming to decrease and relieve patients' symptoms and improve overall Quilty Of Life.
Methods: We searched PubMed, Cochrane Library, Scopus, and web of science databases, in March 2022. and all identified results were checked against the eligibility criteria. We assessed the included RCTs for methodological bias risk according to the Cochrane tool, We assessed the quality of the included case-control trials, and cohort studies using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools. We analyzed the data using Open Meta-Analyst. We used the odds ratio (OR) and 95% confidence interval (CI) in the case of dichotomous data and the mean difference in the case of continuous data.
Results: A total of 27 studies were included. Fourteen arms reported by ten studies throughout six subgroups reported LARS score (LARSS) with an overall total number of participants of 216 patients. One study in the antegrade enema after total mesorectal excision subgroup showed that the LARSS was (12.250, 95% CI[8.232, 16.268]).
One study in the biofeedback therapy subgroup showed that the LARSS was (28.6, 95% CI [27.130, 30.070]). As for sacral nerve stimulation, four studies showed that the LARSS in this subgroup was (19.006, 95% CI [11.546, 26.467]). Two studies in the supportive therapy subgroup showed that the LARSS was (26.044, 95% CI [23.152, 28.937]). The other two studies estimated that the LARSS in the tibial nerve stimulation subgroup was (28.818, 95% CI [25.630, 32.006]). For transanal irrigation, four studies showed that the LARSS in this subgroup was (14.821, 95% CI [11.297,18.346]).
Eleven arms from ten studies reported infection outcome with 262 patients. One study in antegrade enema after total mesorectal excision subgroup showed that the incidence of infection was 3.8% (95% CI [-6.6%, 14.3%]). One study in the colonic pouch subgroup showed that the incidence of infection was 3.2% (95% CI [-1.2%, 7.6%]). Seven studies in the sacral nerve stimulation subgroup showed that the incidence of infection was 9.9% (95% CI [5.5%, 14.3%]). One study in the side-to-end anastomosis subgroup showed that the incidence of infection was 3.8% (95% CI [-6.6%, 14.3%]).
Conclusion: All of the mentioned interventions are candidates to be among the rehabilitation treatments for LARS patients that improve symptoms and quality of life. However, there is an urgent need for more studies, mainly prospective ones, on larger numbers of participants and different periods, with the need to use various assessment and follow-up instruments to confirm the best of these therapeutic interventions.
Figure 1: Forest plot of Low anterior resection syndrome score
Figure 2: Forest plot of infection rate
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