Transanal irrigation for low anterior resection syndrome: a systematic review and narrative synthesis with emphasis on nurse-led implementation.
Diego Lopane, Filippo Bianchi, Daniela Cattani et al.
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In 30 seconds
This systematic review and narrative synthesis examined transanal irrigation (TAI) for adults with low anterior resection syndrome after sphincter-preserving rectal surgery, including evidence on nurse-led implementation. Four studies—two randomised trials, one prospective observational study and one mixed-methods study—included 332 patients. Across studies, LARS scores fell by 8.5-23 points, and 68-82% of patients achieved clinically meaningful improvement (≥4 points MCID). No serious adverse events were reported. Adherence was higher in studies with structured nurse-led education and follow-up, although the evidence was heterogeneous and no formal meta-analysis was conducted.
Key findings
- Across studies, TAI reduced LARS scores by 8.5-23 points; 68-82% of patients achieved clinically meaningful improvement (≥4 points MCID).
- Minor adverse events occurred in 1.2% of patients (3/242); no serious adverse events were reported.
- Adherence was 85-100% in studies with structured nurse-led support, versus 60-78% with minimal-to-moderate nursing involvement.
Why it matters
LARS can substantially affect quality of life after rectal surgery, and this review suggests TAI may improve symptoms with few reported adverse events. The higher adherence observed alongside structured nursing support highlights implementation as a potentially important part of care. However, evidence certainty varied, and the findings do not establish long-term effectiveness or a standard delivery approach.
What to keep in mind
Only four heterogeneous studies were included, with a total of 332 patients and median follow-up of 4 months. No formal meta-analysis was possible; certainty ranged from very low to moderate.