Total mesorectal excision for low rectal cancer can result in a cluster of debilitating symptoms—including fecal incontinence, stool fragmentation, urgency, and obstructive defecation—collectively known as Low Anterior Resection Syndrome (LARS). Among patients undergoing intersphincteric resection, these symptoms are often more severe due to the extent of sphincteric compromise. Electrical neurostimulation has emerged as a therapeutic option aimed at modulating motor and sensory nerve function in the anorectal region to alleviate these symptoms. This study aims to evaluate the efficacy of targeted electrostimulation therapy in patients with severe LARS following intersphincteric resection.

Patients referred to the Anorectal Physiology Unit of the Coloproctology Service at Hospital General de México Dr. Eduardo Liceaga for severe LARS, treated with specific electrostimulation, period 2018 to 2023. The LARS questionnaire and Wexner score were applied at the beginning and at the end of the therapies. Therapies once a week for 12 weeks, with endoanal or transcutaneous electro for 20 minutes. Interference energy was used for fecal incontinence, asymmetric biphasic energy for fecal urgency, and symmetric biphasic energy for pain.

A total of 14 patients were analyzed. and the findings were: fecal incontinence 86%, anal pain 7%, and fecal urgency 7%. LARS score is recorded before and after therapy.

Among the findings of the anorectal manometry (ARM) in patients with fecal incontinence (FI), 42% presented with hyposensitivity, 25% with hypersensitivity, and 33% had normal rectal sensitivity. Additionally, 8% showed type 1 dyssynergic defecation. Regarding sphincter tone alterations, 33% had internal anal sphincter (IAS) hypotonia, and 67% had hypotonia of both the IAS and the external anal sphincter (EAS).
Endoanal ultrasound (EAUS) was performed in 58% of the patients, with the following findings: 14% showed no structural abnormalities, 72% had sphincter defects (internal, external, or multifragmented), and 14% exhibited fibrosis due to prior surgical intervention.
The patient with anal pain showed IAS hypotonia with type IV dyssynergic defecation on ARM, while EAUS revealed no structural abnormalities. The other patient, who presented with fecal urgency, had rectal hypersensitivity on ARM and mid-level anal sphincter fibrosis on EAUS.
The overall improvement rate was 77% (range: 60–90; standard deviation: 11.38). Specific improvement percentages in FI were as follows: 33% of patients achieved a 90% improvement, 25% had 80% improvement, another 25% had 70% improvement, and 17% experienced a 60% improvement. Improvement for fecal urgency was 70%, and for anal pain, 60%.

Specific electrostimulation therapy is an alternative treatment in patients with LARS.

Annicchiarico A, Martellucci J, Solari S, Scheiterle M, Bergamini C, Prosperi P. Low anterior resection syndrome:can it be prevented?Int J Colorectal Dis. 2021;36(12):2535-52.
Altomare DF, Picciariello A, Ferrara C, Digennaro R, Ribas Y, De Fazio M. Short-term outcome of percutaneous tibial nerve stimulation for low anterior resection syndrome:results of a pilot study. Colorectal Dis. 2017;19(9):851-6.
Paz C, Fernández M. Síndrome de resección anterior baja en pacientes con cancer de recto medio inferior. ¿Quémás podemos hacer?Rev Cir. 2021;73(1):80-90.