The Efficacy of Antegrade and Retrograde Enemas Management in Low Anterior Resection Syndrome and Improving the Rate of Ileostomy Reversal

The LARS score consists of five components and the total score, ranging from 0 to 42. Severity levels are categorized as follows: no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points).

Quality of sleep was evaluated by Pittsburgh Quality Index (PSQI). The PSQI assesses a participant's sleep quality in the previous month using 18 items divided into 7 components. Each component is graded between 0 and 3. The total score is 0-21, with higher scores indicating poorer sleep quality.

The Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (MSKCC BFI) is used to assess bowel function. This questionnaire comprises three dimensions, totaling 18 items. The total scale score ranged from 18 to 90, with higher scores indicating better bowel function.

The quality of life was assessd by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal Cancer 29 (EORTC QLQ-CR29). The scale includes 4 functional domains, 19 symptom domains, and 6 stoma-related items. Each item, except for item 18 (which indicates the presence or absence of a stoma), is rated on a 4-point scale: 'not at all,' 'a little,' 'quite a bit,' and 'very much,' corresponding to scores of 1 to 4, respectively. Scores are converted into standardized values ranging from 0 to 100 using polarization. Higher scores in the functional domains indicate better function, whereas higher scores in the symptom domains reflect more severe symptoms.

The psychosocial adjustment level of patients with enterostomy were evaluated using the Ostomy Adjustment Inventory-20 (OAI-20). OAI-20 adopts a 5-level Likert scoring method, forward scores range from 0 (strongly disagree) to 4 (strongly agree), while reverse scores range from 4 (strongly disagree) to 0(strongly agree). Total scores range from 0 to 80, where scores <40 indicate low psychosocial adjustment, scores between 40 and 59 indicate medium psychosocial adjustment, and scores ≥60 indicate high psychosocial adjustment levels.

The Stoma-Specific Quality of Life-Questionnaire (Stoma QoL) was designed specifically for patients with ostomy and consists of 20 entries, each of which is divided into 4 levels: always, sometimes, rarely, never, with a score ranging from 1 to 4. The ratings range from 20 to 80, with higher levels indicating higher HRQoL.

This was designed to assess anal feces and discomfort sensations in stoma patients during their stoma time. The questionnaire consisted of four main questions dealing with frequency of defecation, perception of bowel movement, sensation of irritation in the anal region, and the patient's reaction to irritants. These four specific questions as follow:

• In the last week, how often have you felt discharge oozing from around your anus?
• In the last week, how often have you felt a bowel movement around your anus?
• In the last week, how often have you felt irritation in your bowel movements?
• Do you experience skin irritation or discomfort from anal discharge? (five-point scale: "very", "rather", "generally", "somewhat", "not at all")