ThTP7.4 Role of transanal irrigation in the management of low anterior resection syndrome: an evidence synthesis by meta-analysis

Abstract Objective Low anterior resection syndrome (LARS) may be a debilitating postoperative anorectal dysfunction causing negative impact on the health-related quality of life in patients undergoing low anterior resection for rectal diseases. The objective of this review is to evaluate the role of transanal irrigation (TAI) in patients with LARS. Methods Randomized controlled trials (RCTs) comparing the effectiveness of TAI against baseline conventional therapies in patients with diagnosed LARS were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4. Results Three RCTs reported the effectiveness of TAI on 109 patients with LARS. Two RCTs compared TAI against conventional conservative therapies whereas one RCT reported the comparison of TAI versus tibial nerve stimulation. There were 53 patients in the TAI group and 56 patients were in no-TIA group. In the random effects model analysis, TAI was associated with the reduced low anterior resection score [standardised mean difference -2.32, 95%, CI (-3.98, -0.67), Z = 2.75, P=0.006] and lower faecal incontinence score [standardised mean difference -1.62, 95%, CI (-3.06, -0.17), Z = 2.19, P=0.03] compared to other therapies. There was significant heterogeneity (Tau2 = 1.85; Chi2 = 20.78, df = 2; (p < 0.0001; I2 = 90 %) among included studies. Conclusion TAI has shown clinically proven advantage to improve LARS related anorectal dysfunction. However, due to paucity of the randomised trials, and significant clinical as well methodological diversity among included studies, these findings should be taken cautiously.