Low Anterior Resection Syndrome: A Not Uncommon Complication of Transanal Endoscopic Microsurgery

Michael F Horaist, MD, Philip A Cole Ii, MD, Andrew M Werner, MD FACS, Michael D Stratton, MD FACS, W Reid Grimes, MD FACS, Philip A Cole, MD FACS. LSU Health Shreveport


Transanal Endoscopic Microsurgery (TEM) allows for excision of middle and high rectal lesions utilizing a minimally-invasive technique. Low anterior resection syndrome (LARS) includes a constellation of symptoms that typically follows colorectal/coloanal anastomosis. The most pronounced symptoms include frequency, urgency, and/or incontinence. The goal of this study was to review our TEM experience for the treatment of rectal neoplasia and monitor the subsequent development of LARS.
100 patients underwent TEM from August 2005 to July 2011 after receiving 2 Fleets enemas on the morning of surgery. All patients were admitted overnight, given clear liquids post-op, and discharged the following morning once tolerating a diet and voiding.
The average follow-up of these 100 patients was 19.2 months. Complications following this minimally-invasive procedure (including frequency, urgency, bleeding, infection, incontinence, and recurrence) occurred in 16 out of 100 patients. The positive margin rate was 5% leading to an equivalent recurrence rate. LARS occurred in 11/100 patients.
Although better tolerated than more extensive resections, TEM is associated with a risk of functional complications. LARS has traditionally followed resection with low anastamosis; however, TEM has led to similar symptomatology in 16% of our patients. Improvement within one year was noted in 91% of those patients.

Session Number: Poster – Poster Presentations
Program Number: P084
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