Rehabilitation of patients with low anterior resection syndrome

Aim: to develop a conservative rehabilitation program for patients with severe symptoms of LARS.

Patients and methods: since January 2019, 50 patients after low anterior resection were included in the study. The main group included 25 patients who underwent biofeedback therapy and tibial neuromodulation in 3–6 months after surgery. Functional results before and after treatment were evaluated by anorectal manometry. The control group included 25 patients, according to the Propensity score matching.

Results: the median score on the LARS scale, in the main group was 41.0 ± 2.8 points, in the control — 38 ± 4. With sphincterometry, the median pressure at rest before treatment was 30.0 ± 7.8, with a voluntary contraction of 140.6 ± 56.0 mm Hg. After the conservative treatment, patients in the main group had significantly better results: the median score on the LARS scale decreased from 41 ± 2.8 to 17 ± 8 points (p < 0.0001), the median pressure after treatment increased from 30.0 ± 7.8 to 36.0 ± 8.0 (p = 0.004), with a voluntary contraction from 140.6 ± 56.0 to 157.5 ± 53.2 mmHg (p = 0.008). Comparing the results of the questionnaire of the main group with the control group after the stoma closure and after 12 months, it turned out that in the main group there was a significant decrease in the severity of LARS: 17.0 ± 8.0 scores vs. 35.0 ± 4.5 (p = 0.0003), which shows an improvement in the tone and contractility of the sphincter after conservative treatment.

Conclusion: comprehensive biofeedback therapy and tibial neuromodulation improves the functional results of patients with severe LARS.

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