{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T07:30:37Z","timestamp":1782891037227,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long-term bowel dysfunction can impact a significant proportion of patients following anterior resection. The aim of this study was to assess the efficacy of transanal irrigation (TAI) to treat low anterior resection syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults (\u2265 18 years) with major low anterior resection syndrome (score &amp;gt; 30) at least 12 months after low anterior resection were enrolled at four European centres. Eligible patients were randomized 1 : 1 using block randomization to the TAI group or best supportive care group. The primary endpoint was the feasibility of TAI measured by treatment adherence or switch of therapy. Secondary endpoints included bowel function, quality of life and study-specific patient satisfaction questions. Outcome evaluators and the statistical team were blinded to allocation, whereas participants and caregivers were unblinded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty-one patients were randomized, of which 40 (19 TAI; 21 best supportive care) completed follow-up; 1 patient in the TAI group was excluded due to fistula surgery. At 12 months, low anterior resection syndrome (median 3 (range 0\u201339) versus 36 (2\u201342); P &amp;lt; 0.001) and Wexner scores (median 0 (0\u201315) versus 13 (4\u201320); P &amp;lt; 0.001) were significantly lower in the TAI group compared with the control group. The Measure Yourself Medical Outcome Profile score was lower in the TAI group after 3 months (median 2 (0\u201311) versus 11 (7\u201312); P &amp;lt; 0.001). In addition, patients in the TAI group achieved higher Memorial Sloan Kettering Cancer Center Bowel Function Instrument scores after 12 months (median 89 (37\u201390) versus 39 (28\u201361); P &amp;lt; 0.001). Adherence was high, with 15 (75%) maintaining daily irrigation, and patient satisfaction measures favoured TAI. Two mild procedure-related adverse events (tenesmus, dizziness) were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This randomized clinical feasibility study confirms that TAI is feasible and has high acceptability for patients. It leads to better functional outcomes and improvements in quality of life compared with the best supportive care for patients with low anterior resection syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration number<\/jats:title>\n                    <jats:p>NCT05920681 (http:\/\/www.clinicaltrials.gov).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag022","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T12:32:35Z","timestamp":1770726755000},"source":"Crossref","is-referenced-by-count":0,"title":["Transanal irrigation for low anterior resection syndrome treatment: international multicentre randomized clinical trial"],"prefix":"10.1093","volume":"10","author":[{"given":"Ignas","family":"Civilka","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Vilnius University , Vilnius ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Klimovskij","sequence":"additional","affiliation":[{"name":"Department of General and abdominal Surgery, East Sussex Healthcare NHS Trust, Hastings ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrej","family":"Aleinikov","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, National Cancer Institute , Vilnius ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narimantas E","family":"Samalavicius","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University , Vilnius ,","place":["Lithuania"]},{"name":"Department of General Surgery, Republic Vilnius University Hospital , Vilnius ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Migl\u0117","family":"Sakalauskait\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3692-8962","authenticated-orcid":false,"given":"Audrius","family":"Dulskas","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University , Vilnius ,","place":["Lithuania"]},{"name":"Department of Surgical Oncology, National Cancer Institute , Vilnius ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026063010153377800_zrag022-B1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1054\/bjoc.1999.1052","article-title":"Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes","volume":"82","author":"Allal","year":"2000","journal-title":"Br J Cancer"},{"key":"2026063010153377800_zrag022-B2","first-page":"713","article-title":"Defining low anterior resection syndrome: a systematic review of the literature","volume":"19","author":"Keane","year":"2017","journal-title":"Colorectal Dis Off J Assoc Coloproctology G B Irel"},{"key":"2026063010153377800_zrag022-B3","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1002\/bjs5.50312","article-title":"Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study","volume":"4","author":"Pieniowski","year":"2020","journal-title":"BJS Open"},{"key":"2026063010153377800_zrag022-B4","doi-asserted-by":"crossref","first-page":"11882","DOI":"10.1038\/s41598-020-68900-8","article-title":"Long-term bowel dysfunction following low anterior resection","volume":"10","author":"Dulskas","year":"2020","journal-title":"Sci Rep"},{"key":"2026063010153377800_zrag022-B5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s00384-016-2659-6","article-title":"Long-term functional follow-up after anterior rectal resection for cancer","volume":"32","author":"Sturiale","year":"2017","journal-title":"Int J Colorectal Dis"},{"key":"2026063010153377800_zrag022-B6","first-page":"461","article-title":"Management guidelines for low anterior resection syndrome\u2014the MANUEL project","volume":"23","author":"Christensen","year":"2021","journal-title":"Colorectal Dis Off J Assoc Coloproctology G B Irel"},{"key":"2026063010153377800_zrag022-B7","doi-asserted-by":"crossref","first-page":"778","DOI":"10.3390\/cancers15030778","article-title":"Management of low anterior resection syndrome (LARS) following resection for rectal cancer","volume":"15","author":"Rosen","year":"2023","journal-title":"Cancers (Basel)"},{"key":"2026063010153377800_zrag022-B8","doi-asserted-by":"crossref","first-page":"194","DOI":"10.4174\/astr.2019.97.4.194","article-title":"Efficacy of biofeedback therapy for objective improvement of pelvic function in low anterior resection syndrome","volume":"97","author":"Lee","year":"2019","journal-title":"Ann Surg Treat Res"},{"key":"2026063010153377800_zrag022-B9","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1097\/DCR.0b013e318221a934","article-title":"Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery","volume":"54","author":"Kim","year":"2011","journal-title":"Dis Colon Rectum"},{"key":"2026063010153377800_zrag022-B10","doi-asserted-by":"crossref","first-page":"E787","DOI":"10.1111\/ans.14871","article-title":"Using sacral nerve modulation to improve continence and quality of life in patients suffering from low anterior resection syndrome","volume":"88","author":"Croese","year":"2018","journal-title":"ANZ J Surg"},{"key":"2026063010153377800_zrag022-B11","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s10151-017-1612-1","article-title":"Sacral neurostimulation for low anterior resection syndrome after radical resection for rectal cancer: evaluation of treatment with the LARS score","volume":"21","author":"D\u2019Hondt","year":"2017","journal-title":"Tech Coloproctol"},{"key":"2026063010153377800_zrag022-B12","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.12968\/bjon.2021.30.21.1226","article-title":"Using transanal irrigation in the management of low anterior resection syndrome: a service audit","volume":"30","author":"Embleton","year":"2021","journal-title":"Br J Nurs Mark Allen Publ"},{"key":"2026063010153377800_zrag022-B13","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s10151-018-1829-7","article-title":"Role of transanal irrigation in the treatment of anterior resection syndrome","volume":"22","author":"Martellucci","year":"2018","journal-title":"Tech Coloproctology"},{"key":"2026063010153377800_zrag022-B14","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s10151-020-02261-2","article-title":"\u201cProphylactic\u201d transanal irrigation (TAI) to prevent symptoms of low anterior resection syndrome (LARS) after rectal resection: results at 12-month follow-up of a controlled randomized multicentre trial","volume":"24","author":"Rosen","year":"2020","journal-title":"Tech Coloproctology"},{"key":"2026063010153377800_zrag022-B15","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1093\/bjs\/znad078","article-title":"Low anterior resection syndrome after rectal resection management: multicentre randomized clinical trial of transanal irrigation with a dedicated device (cone catheter) versus conservative bowel management","volume":"110","author":"Meurette","year":"2023","journal-title":"Br J Surg"},{"key":"2026063010153377800_zrag022-B16","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/SLA.0000000000005482","article-title":"A randomized controlled clinical trial of transanal irrigation versus conservative treatment in patients with low anterior resection syndrome after rectal cancer surgery","volume":"277","author":"Pieniowski","year":"2023","journal-title":"Ann Surg"},{"key":"2026063010153377800_zrag022-B17","first-page":"461","article-title":"Randomized clinical trial of prophylactic transanal irrigation versus supportive therapy to prevent symptoms of low anterior resection syndrome after rectal resection","volume":"3","author":"Rosen","year":"2019","journal-title":"BJS Open"},{"key":"2026063010153377800_zrag022-B18","doi-asserted-by":"crossref","first-page":"517","DOI":"10.3109\/00365520903583855","article-title":"Transanal irrigation for disordered defecation: a systematic review","volume":"45","author":"Christensen","year":"2010","journal-title":"Scand J Gastroenterol"},{"key":"2026063010153377800_zrag022-B19","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1007\/s10350-004-0942-z","article-title":"The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer","volume":"48","author":"Temple","year":"2005","journal-title":"Dis Colon Rectum"},{"key":"2026063010153377800_zrag022-B20","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s10151-015-1424-0","article-title":"Validity and reliability of a Lithuanian version of low anterior resection syndrome score","volume":"20","author":"Samalavicius","year":"2016","journal-title":"Tech Coloproctology"},{"key":"2026063010153377800_zrag022-B21","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/SLA.0b013e31824f1c21","article-title":"Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer","volume":"255","author":"Emmertsen","year":"2012","journal-title":"Ann Surg"},{"key":"2026063010153377800_zrag022-B22","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF02050307","article-title":"Etiology and management of fecal incontinence","volume":"36","author":"Jorge","year":"1993","journal-title":"Dis Colon Rectum"},{"key":"2026063010153377800_zrag022-B23","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1136\/bmj.312.7037.1016","article-title":"Measuring outcomes in primary care: a patient generated measure, MYMOP, compared with the SF-36 health survey","volume":"312","author":"Paterson","year":"1996","journal-title":"BMJ"},{"key":"2026063010153377800_zrag022-B24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s003840050072","article-title":"Pathological features of rectal cancer after preoperative radiochemotherapy","volume":"12","author":"Dworak","year":"1997","journal-title":"Int J Colorectal Dis"},{"key":"2026063010153377800_zrag022-B25","first-page":"93","article-title":"The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"2026063010153377800_zrag022-B26","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/BF02471596","article-title":"Self washout method for defecational complaints following low anterior rectal resection","volume":"19","author":"Iwama","year":"1989","journal-title":"Jpn J Surg"},{"key":"2026063010153377800_zrag022-B27","first-page":"e335","article-title":"Transanal irrigation improves quality of life in patients with low anterior resection syndrome","volume":"13","author":"Rosen","year":"2011","journal-title":"Colorectal Dis Off J Assoc Coloproctology G B Irel"},{"key":"2026063010153377800_zrag022-B28","first-page":"O76","article-title":"Acceptability and benefit of rectal irrigation in patients with low anterior resection syndrome: a qualitative study","volume":"20","author":"McCutchan","year":"2018","journal-title":"Colorectal Dis Off J Assoc Coloproctology G B Irel"},{"key":"2026063010153377800_zrag022-B29","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/DCR.0000000000002005","article-title":"Feasibility study of transanal irrigation using a colostomy irrigation system in patients with low anterior resection syndrome","volume":"65","author":"Rodrigues","year":"2022","journal-title":"Dis Colon Rectum"},{"key":"2026063010153377800_zrag022-B30","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1002\/bjs.9223","article-title":"Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer","volume":"100","author":"Emmertsen","year":"2013","journal-title":"Br J Surg"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/3\/zrag022\/68295798\/zrag022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/3\/zrag022\/68295798\/zrag022.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:44:51Z","timestamp":1782884691000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag022\/8679209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5,12]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag022","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,12]]},"article-number":"zrag022"}}