Optimal interventions for low anterior resection syndrome: Bayesian network meta-analysis of randomized controlled trials.

Abstract

Background: The optimal intervention for managing low anterior resection syndrome (LARS) remains uncertain. This Bayesian network meta-analysis was conducted to compare and rank the effectiveness of various interventions on LARS.

Methods: Randomized controlled trials (RCTs) addressing interventions for LARS were extracted from six electronic databases until September 2023. A network meta-analysis was performed using a Bayesian random-effects and consistency model. The results were presented as mean differences (MDs) with credible interval (CrI) or standardized mean differences (SMDs) with CrI.

Results: A total of 11 RCTs were included. In the short term (≤ 6 months), transanal irrigation (TAI) had significant positive impacts on overall LARS symptoms (MD (95% CrI) -14.13 (-20.11, -7.83)) and the severity of bowel incontinence (SMD (95% CrI) -1.34 (-1.97, -0.71)) compared with the control group. Pelvic floor rehabilitation (PFR) also exhibited significant improvements in bowel incontinence as compared with the control group (SMD (95% CrI) -0.56 (-0.88, -0.23)). TAI was ranked highest for reducing LARS symptoms, followed by PFR, and percutaneous tibial nerve stimulation (PTNS). In the long term (> 6 months), the results indicated that TAI was most likely to rank first, followed by PTNS, and PFR; however, no significant differences were observed.

Conclusions: In the short term, TAI was identified as the most effective treatment for managing LARS, followed by PFR. Both TAI and PTNS demonstrated promising potential in enhancing bowel function over the long term. Further trials are needed to confirm these findings.