The role of colonic motility in low anterior resection syndrome

Abstract

Low anterior resection syndrome (LARS) describes the symptoms and experiences of bowel dysfunction experienced by patients after rectal cancer surgery. LARS is a complex and multifactorial syndrome exacerbated by factors such as low anastomotic height, defunctioning of the colon and neorectum, and radiotherapy. There has recently been growing awareness and understanding regarding the role of colonic motility as a contributing mechanism for LARS. It is well established that rectosigmoid motility serves an important role in coordinating rectal filling and maintaining continence. Resection of the rectosigmoid may therefore contribute to LARS through altered distal colonic and neorectal motility. This review evaluates the role of colonic motility within the broader pathophysiology of LARS and outlines future directions of research needed to enable targeted therapy for specific LARS phenotypes.

Specific Septic Complications after Rectal Cancer Surgery: A Critical Multicentre Study

“…We should not forget the damage to the superior and inferior hypogastric plexuses and to the genitourinary pelvic nerves that may occur during the dissection. Anastomoses 3–4 cm from the anal opening are responsible for the highest rate of functional, fistular and stenotic complications [ 22 ].…”

“…Future technologies may be able to use colon and anal canal manometry for the non-invasive study of motility and thus choose the most effective therapies for LARS patients. This would be an essential step towards improving the quality of life of these patients [ 22 ]. Other complications have also been described: dysuria, sexual dysfunction, wound infections, etc.…”

Clinical utility of trans‐sacral magnetic stimulation‐evoked sphincter potentials and high‐density electromyography in pelvic floor assessment: Technical evaluation

“…The pathophysiology of FI is multifactorial, with important contributors to continence including pudendal nerve sensory and motor function, stool consistency, colorectal motility, pelvic floor and sphincter complex muscle function, and the presence of organ prolapse [16,17]. Current diagnostic tools to differentiate the relative contributions of these aetiologies at the patient level include anorectal manometry, defecating proctograms, and endoanal ultrasound, with PNTML being rarely used.…”

Care of Post-Operative Altered Bowel Function in Colorectal Cancer Patients

“…When patients received anal-saving surgery, it may resect distal sigmoid, whole rectum, total mesorectum and partial or/and total internal sphincter or/and external sphincter, as well as straight down the stump of colon to create a colon-to-colon or coloanal anastomosis for bowel continuum [13][14][15]. Potential points of pelvic nerve injury during rectal dissection include (see Figure 2): (1) Damage to the superior hypogastric plexus from tension or high division of the inferior mesenteric artery, (2) Injury to the main trunks of the hypogastric nerve during retrorectal dissection; (3) Injury to the inferior hypogastric plexus and nervi erigentes during the mobilization of lateral stalks, and (4) injury to the periprostatic plexus during the dissection of Denonvilliers' fascia [16][17][18].…”