Chronic sacral spinal nerve stimulation for fecal incontinence: Long-term results with foramen and cuff electrodes

Citation
Ke. Matzel et al., Chronic sacral spinal nerve stimulation for fecal incontinence: Long-term results with foramen and cuff electrodes, DIS COL REC, 44(1), 2001, pp. 59-66
Citations number
37
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
DISEASES OF THE COLON & RECTUM
ISSN journal
0012-3706 → ACNP
Volume
44
Issue
1
Year of publication
2001
Pages
59 - 66
Database
ISI
SICI code
0012-3706(200101)44:1<59:CSSNSF>2.0.ZU;2-W
Abstract
PURPOSE: Sacral spinal nerve stimulation is a new therapeutic approach for patients with severe fecal incontinence owing to functional deficits of the external anal sphincter. It aims to use the morphologically intact anatomy to recruit residual function. This study evaluates the long-term results o f the first patients treated with this novel approach applying two techniqu es of sacral spinal nerve stimulator implantation. METHODS: Six patients un derwent either of two techniques for electrode placement: one "closed" (ele ctrodes placed through the sacral foramen) and one "open" (cuff electrodes placed after sacral laminectomy). Follow-up evaluation of their continence status ranged from 5 to 66 months. RESULTS: Incontinence improved in all pa tients. The percentage of incontinent bowel movements decreased during chro nic stimulation from a mean of 40.2 percent to 2.8 percent, and the Wexner score decreased from a mean of 17 to 2. The function of the striated anal s phincter improved during chronic stimulation: maximum squeeze pressure incr eased from a mean of 48.5 mmHg to 92.7 mmHg, and median squeeze pressure in creased from a mean of 37.3 mmHg to 72.5 mmHg. No complications were encoun tered perioperatively or postoperatively. Two devices had to be removed bec ause of intractable pain, in one patient at the site of the electrode after five months and in the other at the site of the impulse generator after 45 months. CONCLUSION: Long-term sacral spinal nerve stimulation persistently improves continence and increases striated anal sphincter function in pati ents with fecal incontinence owing to functional deficits, but in whom the striated anal sphincter is morphologically intact. Two different operative approaches can be applied effectively.