Consensus-driven protocol for transanal irrigation in patients with low anterior resection syndrome and functional constipation.

M Grilli, P Rossitti, A Spolini, G Torchia, E Valloncini, D Zattoni, E Zucchi, P Biotti, A Cambareri, G Coniglio, K Nepote Fus, S Graziani, D Piccolo, A Grego, E Livio, L Manganini, P Mazzeo, A Minonne, M Mirafiori, G Negri, V Palazzolo, C Di Pasquale, V Tantolo, S Borin, I Clementi, S Costa, M Carrera, E Rosati, E Guerra, S Cornaglia, A Bondurri, A Coppola, J Martellucci, E Falletto, S Ascanelli, G Gallo, C Bottini, E Caproli, G Cestaro, L Chimisso, G Clarizia, C Guerci, C Lambiase, A Lauretta, P Luffarelli, M C Neri

Journal: Techniques in coloproctology 2024;28(1):153

PMID: 39523239

Full Text on Springer View on PubMed

Abstract

BACKGROUND

This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation.

METHODS

The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75% agreement.

RESULTS

In the first round, nurses achieved consensus on all statements, while clinicians required a second round to reach consensus, particularly regarding prescription and technical aspects. Clinicians reached consensus on prescribing TAI as a second-line treatment for LARS and functional constipation, following the failure of conservative measures such as dietary and lifestyle interventions. Timing considerations for patients with LARS encompass avoiding TAI within 1 month of stoma closure and waiting a minimum of 3 months. For functional constipation, TAI is recommended for slow transit constipation, emphasizing its preference over surgical options. Consensus was also reached on the choice of catheter for patients with LARS, training requirements for patients and caregivers, preparation of the patient's intestine before TAI, and recommended irrigations.

CONCLUSIONS

This consensus study successfully developed a standardized TAI protocol for LARS and functional constipation. It provides comprehensive guidelines for prescription and technical aspects, addressing the challenges encountered by healthcare professionals. The protocol aims to enhance patient care, improve treatment outcomes, and contribute to the advancement of TAI.

Address: Unit of Emergency Surgery, Careggi University Hospital Largo Giovanni Alessandro Brambilla, 350134, Florence, Italy. [email protected].; Department of Surgical Sciences, Città Della Salute e Della Scienza, University of Torino, Turin, Italy.; Surgical Department, University Hospital Ferrara, Ferrara, Italy.; Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Milan, Italy.; Digestive Surgery - European Institute of Oncology, IRCCS - Milan, Milan, Italy.; General Surgery Unit, Humanitas Materdomini Institute, Castellanza (VA), Italy.; A. Murri Hospital, Fermo, Italy.; ASL TO4, Ciriè, Turin, Italy.; General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy.; Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy.; General Surgery Unit, Sondrio Civil Hospital, ASST Valtellina e Alto Lario, Sondrio, Italy.; Department of Surgery "Pietro Valdoni", Policlinico Umberto I "Sapienza", University of Rome, Rome, Italy.; General Surgery Division, Koelliker Hospital, Turin, Italy.; Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.; Department of Surgery, Sapienza University of Rome, Rome, Italy.; Luigi Sacco University Hospital, Milan, Italy.; Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy.; Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy.; Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.; Pio Albergo Trivulzio Institute, Milan, Italy.; "G. da Saliceto" Civil Hospital in Piacenza, AUSL Piacenza, Piacenza, Italy.; General and Emergency Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy.; Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy.; General Surgery Unit, Policlinico di Bari, Bari, Italy.; General Surgery Unit, ASST Spedali Civili di Brescia, Brescia, Italy.; Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy.; Pelvic Floor Pathology Center, Careggi University Hospital, Florence, Italy.; Azienda Sanitaria Locale di Ferrara - Distretto Centro Nord, Ferrara, Italy.; OU General Surgery, S. Lenonardo Hospital, Castellammare di Stabia, Naples, Italy.; Santa Rita Clinic, Vercelli, Italy.; Spedali Civili di Brescia Hospital, Brescia, Italy.; ASST Fatebenefratelli Sacco, University Hospital, Milan, Italy.; Villa dei Gerani Clinic, Vibo Valencia, Italy.; San Camillo Forlanini Hospital, Rome, Italy.; Ospedali Riuniti Villa Sofia-Cervello Hospital, Palermo, Italy.; Surgical Department, Ostomy and Pelvic Floor Rehabilitation Center, Azienda Sanitaria Universitaria Friuli Centrale, Santa Maria della Misericordia, Udine, Italy.

DOI: 10.1007/s10151-024-03033-y

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MeSH Terms: Humans, Constipation, Therapeutic Irrigation, Delphi Technique, Consensus, Syndrome, Clinical Protocols, Postoperative Complications, Anal Canal, Surveys and Questionnaires, Female, Male, Low Anterior Resection Syndrome