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Page 6 of 13 Climent et al. Mini-invasive Surg 2018;2:45 I http://dx.doi.org/10.20517/2574-1225.2018.62

Postoperative ileus. Intestinal obstruction
Postoperative ileus (POI) is defined as a transient cessation of coordinated bowel motility after surgical
[42]
intervention, which prevents the effective transit of intestinal contents or tolerance of oral intake . POI
can be secondary of an intra-abdominal complications such as an abscess or AL, but may occur ab-initio,
in the context of surgical stress response, which stimulates inhibitory reflexes and releases inflammatory
[43]
mediators resulting in impaired bowel motility .
Some authors have suggested that laparoscopic surgery is associated with less frequent POI compared
to open surgery due to the minimal intestinal manipulation leading to decreased local inflammatory
[3,5]
response . However, there is a dearth of evidence and no accepted consensus that laparoscopic surgery
[1]
in major colorectal surgery is protective against POI . To date, no good pharmacological treatment is
[43]
available to diminish POI but chewing sugarless gum after surgery and early introduction of enteral
nutrition after rectal surgery have been associated with a significant reduction in the time to return of
[44]
bowel function .
[45]
Kim et al. defined early postoperative small bowel obstruction (SBO), which differs from the POI in that
it occurs secondary to early adhesions, lasting less than 7 days and usually resolved conservatively. In a
systematic review of postoperative complications after colorectal surgery, early postoperative SBO was the
[30]
second commonest cause of reoperation, which can be managed with a laparoscopic approach . Often,
[8]
the cause of intestinal obstruction is adhesions or an internal hernia .
Cardio-respiratory complications and other conditions
Cardiopulmonary dysfunction has been described in 4% of patients who underwent anterior resection.
Chest infection incidence after LAR is 3.4%-10% [1,18] , being slightly higher after LAR in comparison to open
surgery due to greater operating time. Incidence of deep venous thrombosis has decreased considerably,
with universal adoption of pneumatic calf compression devices, and the use of low molecular weight
[46]
heparin extended up to 30 days postoperatively according to the European Society of Medical Oncology .
Another minor early complication associated with anterior resection is urinary retention, requiring
temporary catheterization, following failed trial of voiding.

LONG-TERM COMPLICATIONS
Long-term morbidities are those that take place between the 30th post-operative day to 3 years following
[47]
LAR .

Low anterior resection syndrome
Sphincter-preserving procedures with a low colorectal or coloanal anastomosis are associated with
bowel dysfunction, which negatively affects the patient’s quality of life (QOL). It may be multifactorial,
including diminished rectal compliance, autonomic neuropraxia or neuropathy and impairment of
[48]
internal anal sphincter tone . Low anterior resection syndrome (LARS) is defined by high frequency
of bowel movements, clustering, incomplete evacuation, diarrhoea, incontinence for flatus and stool,
[49]
urgency, and bowel movements at night . The severity of LARS can be measured with LARS score, a five-
item instrument giving a score from 0 to 42. A range from 30 to 42 on the LARS questionnaire indicates
[50]
major LARS, from 21 to 29 minor LARS, whereas scores below 21 can rule out LARS . Unfortunately,
its incidence is underestimated and its impact under-appreciated, as a recent survey among colorectal
[51]
surgeons of different countries shows . LARS is present in 55.2%-58% of patients who undergo low
LAR [49,52] , being more frequent after a low anastomosis and in young patients who received neoadjuvant
[52]
chemoradiotherapy .
Management of LARS is quite challenging because of a dearth of successful treatment options.
Conservative management consists of dietary adjustment adhering to a low fibre diet, antidiarrheal