Sacral neuromodulation improves bowel function in patients with low anterior resection syndrome

BACKGROUND: Low anterior resection syndrome (LARS) is a common postoperative sequala affecting up to 70% of patients following rectal cancer surgery. Characterized by urgency, frequency, incontinence, and incomplete evacuation, LARS can significantly impair quality of life. Sacral neuromodulation (SNM) has emerged as a potential therapy for patients with refractory symptoms. METHODS: This retrospective single-center study included 43 patients with LARS unresponsive to conservative therapy who underwent SNM between 2017 and 2025. All patients received the InterStim™ device following a positive test phase. Demographic, clinical, and surgical data were collected and analyzed. The primary outcomes were changes in LARS and Wexner incontinence scores. Secondary outcomes included changes in quality of life measured by the Fecal Incontinence Quality of Life (FIQL) questionnaire and Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) survey. RESULTS: LARS scores improved from a mean of 37.9-29.9 (p < 0.001) and Wexner scores from 14.2 to 10.4 (p < 0.001). FIQL scores improved significantly across all subdomains: lifestyle (1.49-2.28, p < 0.001), coping (1.39-2.26, p < 0.001), depression (1.66-2.38 p < 0.001), and embarrassment (1.58-2.40, p < 0.001). PROMIS-10 scores also improved, with physical health increasing from 35.7 to 41.4 (p = 0.01) and mental health from 40.3 to 45.1 (p = 0.02). Six patients required device revision, and three experienced minor complications. CONCLUSIONS: SNM significantly improves bowel function and quality of life in patients with LARS refractory to conservative management and represents a promising therapeutic option.