Guideline for the assessment and management of gastrointestinal symptoms following colorectal surgery—A UEG/ESCP/EAES/ESPCG/ESPEN/ESNM/ESSO collaboration. Part II—Good practice guidance | sequelae to benign diseases

摘要

Benign colorectal resections are performed to address a spectrum of non-oncological conditions, including but not limited to diverticulitis, inflammatory bowel disease (IBD), polyposis coli, functional bowel disorders, and endometriosis. While the surgical procedure mirrors that of oncological cases, the primary distinction lies on the preservation of a greater portion of the mesentery in these non-oncological resections.1 Nevertheless, irrespective of the underlying condition, any type of colorectal resection could have an adverse impact on the patient's bowel function.2-6 Gastrointestinal dysfunction is a prevalent long-term complication after non-oncological colorectal resections. This is particularly the case in diverticulosis patients, where poor functional outcomes have been reported in up to 25% of patients after left hemicolectomy.3, 7 Bowel dysfunction can manifest with a variety of symptoms, including urgency, constipation, faecal incontinence and/or abdominal pain, all of which require different management strategies.8, 9 Recent studies have shown that 80% of patients experience late residual symptoms after colorectal surgery, with 70% of these reporting an improvement in symptom profiles following treatment.10 Similar positive outcomes were observed in a nurse-led clinic,11 highlighting the clinical and socio-economic value of recognising and addressing these complications. Urinary incontinence and sexual dysfunction represent additional potential long-term consequences of colorectal surgery. This guideline focusses primarily on addressing the gastrointestinal symptoms following non-oncological colorectal resection. All long-term sequelae can have a significant impact on patients' overall well-being and quality of life (QoL). For clarity, we will adhere to the term ‘gastrointestinal symptoms’ in this guideline. Gastrointestinal symptoms can lead to a range of long-term sequelae following non-oncological colorectal resections. Each pattern depends on the specific resection type performed due to the differing underlying pathophysiological mechanisms responsible for gastrointestinal dysfunctions. It is important to note that benign colorectal conditions themselves often involve functional disorders, such as functional constipation, faecal incontinence, or abdominal pain, prior to any surgical resection. These functional aspects contribute to a complex interplay of symptoms.12-14 Additionally, the neurochemical changes in the innervation of colonic blood vessels in patients with inflammatory bowel diseases (IBD) may contribute to abdominal pain and the altered bowel habit that may accompany this disease.15, 16 Right sided colonic resections often reduce the capacity for biliary acid absorption.8, 17, 18 Due to the resection of the ileocaecal valve in right sided resections, small bowel bacterial overgrowth may further contribute to bowel dysfunctions.17 These dysfunctions may manifest in symptoms such as loose stool, increased bowel frequency, and/or increased nocturnal defecation.9, 17 Some of these symptoms may improve or resolve spontaneously over time. However, many patients experience persistent bowel dysfunction. We omitted appendectomies if this was the sole resection performed. Left sided colectomies may lead to symptoms such as diarrhoea, stool fragmentation, a feeling of obstruction and prolonged evacuation time.17, 19 The primary aetiology is believed to be the reduced capacity of water absorption after left-sided colonic resections.8 Furthermore, the absence of the rectosigmoid junction, which acts as a high-pressure barrier preventing rapid stool transit into the rectum, may contribute to the development of faecal incontinence.9, 20 Studies investigating functional outcomes after (oncological) rectal resections have identified the Low Anterior Resection Syndrome (LARS), which is considered to be a condition with a multifactorial aetiology.21, 22 Key contributing factors include the loss of reservoir functi