Clinical Scorecard: Sacral Neuromodulation for Low Anterior Resection Syndrome

At a Glance

Key Highlights

• LARS symptoms include urgency, fecal incontinence, increased stool frequency, clustering, and incomplete evacuation.
• Initial management includes dietary and pharmacological interventions and pelvic floor rehabilitation; transanal irrigation may be considered for persistent symptoms.
• In the SANLARS trial, 35 of 46 participants (78%) completed the test phase and underwent permanent implantation.
• SANLARS reported significant improvements at 6 and 12 months in LARS score, continence outcomes, urgency, clustering, bowel-emptying sensation, and quality of life; improvement appeared to diminish at longer-term follow-up but remained statistically significant.
• A SANLARS secondary analysis reported improvement in urinary symptoms. Overall sexual function did not improve significantly; male patients reported greater confidence in maintaining an erection.

Guideline-Based Recommendations

Diagnosis

• The article cites the broadly accepted definition of LARS as disordered bowel function following rectal resection that results in detriment to quality of life.
• The article describes symptoms including urgency, fecal incontinence, increased stool frequency, clustering, and incomplete evacuation.

Management

• The article describes a stepwise, multidisciplinary strategy beginning with dietary and pharmacological interventions and pelvic floor rehabilitation.
• Transanal irrigation may be considered for persistent symptoms.
• For major LARS refractory to optimized conservative treatment, the article describes SNM as a subsequent minimally invasive option.

Monitoring & Follow-up

• The article reports follow-up outcomes including LARS and Wexner scores and validated quality-of-life measures.
• The article reports that improvement appeared to diminish during longer-term follow-up and that symptoms recurred in some patients after stimulator deactivation.
• A secondary analysis reported improved urinary symptoms; overall sexual function did not improve significantly, although male patients reported greater confidence in maintaining an erection.

Risks

• The article does not provide a detailed adverse-event profile for SNM.
• The article notes possible variation in response by symptom phenotype but states that dependable predictors have not been established.
• Some patients experienced symptom recurrence after stimulator deactivation.

Patient & Prescribing Data

Patients with major LARS persisting despite optimized conservative treatment. In SANLARS, 35 of 46 participants (78%) completed the test phase and received permanent implantation.

SANLARS reported significant bowel-symptom and quality-of-life improvements at 6 and 12 months. Improvement appeared to diminish with longer follow-up but remained statistically significant. A secondary analysis reported improved urinary symptoms; overall sexual function did not improve significantly, while male patients reported greater confidence in maintaining an erection.

Clinical Best Practices

• The article describes a stepwise, multidisciplinary approach to LARS management.
• The article describes optimizing conservative treatment before considering SNM for major LARS.
• The article notes uncertainty in patient selection and response prediction, and reports that benefit may diminish or symptoms may recur after device deactivation.
• SANLARS reported bowel and urinary improvements; overall sexual function did not improve significantly, although male patients reported greater confidence in maintaining an erection.

Related Resources & Content