Avaliação da qualidade de vida de pacientes com síndrome da ressecção anterior do reto antes e após o uso de irrigação transanal

Abstract

Anterior resection of the rectum with total mesorectal excision and low or coloanal colorectal anastomosis represents the standard treatment of tumors of the middle and distal thirds of the rectum. After this type of surgery, many patients will have functional symptoms such as anal incontinence, urgency, increased bowel movement frequency and difficulty with bowel emptying, with constant sensation of incomplete bowel movements, characterizing Low Anterior Resection Syndrome - LARS), with a significant negative impact on quality of life. Intestinal irrigation is a method of intestinal lavage in which the patient undergoes training to acquire skills and perform the procedure at home, thereby promoting a scheduled evacuation to empty the intestinal contents and thus avoiding losses during the day. Objectives: to implement the Transanal Intestinal Irrigation (ITA) technique for patients classified as moderate and severe LARS and to evaluate the functional results and their impact on quality of life. Method: patients classified as moderate and severe LARS, after 12 months of conservative treatment, were selected for intestinal irrigation therapy. It was used a kit developed for intestinal irrigation via stoma and applied in transanal irrigation. Patients participated in face-to-face and one-on-one training for three consecutive days to learn the technique and develop the ability to perform the procedure at home daily. Questionnaires assessing patients' bowel function (LARS score), quality of life (SF-36 Quality of Life Questionnaire), severity of anal incontinence (Wexner Score), and specific questionnaires were applied before and after treatment research that measured the impacts of intestinal function on quality of life. Results: 22 patients were studied, 20 with severe LARS and two with moderate LARS. More than 90% of patients reported involuntary loss of stool daily (soiling), 95% reported fragmented bowel movements and incomplete bowel movements, and 77.3% complained of bowel urgency. The adaptation of the stoma irrigation kit for transanal intestinal irrigation proved to be efficient, since 100% of the patients were able to handle it easily and independently after three days of training, and no complications were reported during the 12 months of treatment. After the first month of irrigation, 86.4% of patients no longer had involuntary losses and fragmented bowel movements and 81% reported improvement in bowel urgency. The period of greatest positive impact on the classification of LARS was the first month after initiation of treatment when 86% of patients, initially classified as having severe LARS, were classified as “without LARS”. Improvement in quality of life after the first month occurred in 90.9% of patients. Conclusions: the adapted transanal intestinal irrigation technique was successfully implemented, with good tolerance and reproducibility by the patients, leading to significant improvement of intestinal function and quality of life of patients with moderate and severe LARS.