Transanal irrigation for low anterior resection syndrome-an insider tip Evidence and open questions

A variety of functional problems following rectal resection which have a massive negative impact on the patient's quality of life are summarized under the term low anterior resection syndrome (LARS). After transanal irrigation (TAI) was reported to be an effective treatment option for similar symptoms in other etiologies, it was also successfully introduced as a treatment for patients suffering from a long history of LARS. As a result of a clear improvement of rectal function, a possible prophylactic application of TAI immediately following closure of the protective ileostomy was discussed and evaluated in a controlled randomized trial. Within the first 3 months a significant reduction in the number of defecation episodes (day and night) and the LARS score as well as the Wexner incontinence score was observed. These positive results allow the recommendation to use TAI as a treatment option to reduce LARS in patients following rectal resection; however, some questions remain open (necessary irrigation volume, intervals between irrigation, duration of TAI treatment?) and should be evaluated in further investigations.