Efficiency of transanal irrigation and stimulation of a nerve of the ankle to improve symptoms and quality of life after radical surgery of rectal cancer

INTERVENTION: The randomization sequence will be performed by a computerized randomization algorithm integrated in the program (R v2.9). Patients are randomized to: 1. Transanal irrigation (TAI) with a device (Peristeen, Coloplast DK). Transanal irrigation is performed using the Peristeen system. This consists of a bag that is filled with up to 1000 cc of lukewarm tap water, a coated rectal catheter with a retaining balloon which is inserted in the neorectum, a control unit for the regulation of air and water and a pump for inflating the balloon and for irrigating the rectum. Patients are instructed by a trained stoma nurse for 3‐4 weeks; once the patient is familiar with the procedure, he or she can do it independently at home. Test scores are recorded at baseline, 12, 18 and 24 weeks. 2. Posterior tibial nerve stimulation (PTNS) (Urgent PC, Uroplasty, Nl). PTNS consists of the insertion of a small electrode above the medial malleolus adjacent to the posterior tibial nerve. An adhesive surface is placed under the arch of the foot. Both electrodes are connected to the neurostimuator that generates electricity. A neuromodulation session last 30 minutes. The treatment plan includes 12 weekly sessions, followed by two sessions at two weeks’ intervals. Test scores are recorded at baseline, 12, 18 and 24 weeks. CONDITION: Patients operated for rectal cancer with sphincter preservation and poor postoperative intestinal function ; Surgery PRIMARY OUTCOME: Severity of LARS, measured using the Low Anterior Resection Syndrome scale (LARS) at baseline, 12, 18 and 24 weeks SECONDARY OUTCOME: Measured at baseline, 12, 18 and 24 weeks:; 1. Fecal incontinence, measured using Vaizey’s score; 2. Dysfunctional defecation, measured using Altomare’s score; 3. Quality of life, measured using the QLQ‐C30 Score; 4. Patient satisfaction, measured using the VAS INCLUSION CRITERIA: 1. Patients operated on for rectal cancer with sphincter preservation and functional anastomosis at least one year before study 2. Aged 20 to 80