Functional Outcome of Sacral Nerve Stimulation in Patients With Severe Constipation

• Published in: Diseases of the colon & rectum Vol. 55; no. 8; pp. 876 - 880
• Main Authors: Ortiz, Héctor, de Miguel, Mario, Rinaldi, Marcella, Oteiza, Fabiola, Altomare, Donato F
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01-08-2012; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Chronic Disease; Constipation - diagnosis; Constipation - therapy; Electric Stimulation Therapy - instrumentation; Electric Stimulation Therapy - methods; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Implantable Neurostimulators; Intention to Treat Analysis; Kaplan-Meier Estimate; Lumbosacral Plexus; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Retrospective Studies; Severity of Illness Index; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Young Adult; Human; Prognosis; Wexner constipation score; Gastroenterology; Digestive diseases; Intestinal disease; Percutaneous nerve evaluation; Sacral nerve stimulation; Constipation; Sacral nerve; Percutaneous route
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1097/DCR.0b013e31825bc9af

BACKGROUND:Sacral nerve stimulation has been reported as an effective treatment for constipation.
OBJECTIVE:This study aimed to evaluate the therapeutic efficacy of permanent sacral nerve stimulation on the treatment of idiopathic constipation resistant to medical and behavioral management over a median follow-up period of 25.6 (range, 6–96) months.
DESIGN:A retrospective review of a prospectively maintained institutional review board-approved database was performed.
SETTING:The study was performed at 2 tertiary-care European institutions with expertise in sacral nerve stimulation.
PATIENTS:Patients were considered eligible if they had had symptoms for at least 1 year and if conservative treatment had failed.
INTERVENTION:Patients were tested by percutaneous nerve evaluation before the procedure. If this evaluation was successful, patients underwent sacral nerve therapy with an implanted device.
MAIN OUTCOME MEASURE:Patients were evaluated by means of a bowel function diary and the Wexner constipation score.
RESULTS:A total of 48 consecutive patients (39 females, median age 50.0 years (range, 17–79 years) entered the study. Twenty-three patients were implanted with a permanent stimulator. On an intention-to-treat basis, only 14 of 48 patients (29.2%) met the definition of a successful outcome at the latest follow-up period (median, 25.6 (range, 6–96) months). The mean Wexner score decreased from 20.2 (SD 3.6) at baseline to 5.8 (SD 4.1) at the latest follow-up examination (p < 0.001). However, 6 of 14 patients (42.8%) were still using laxatives and/or enemas at the last follow-up.
LIMITATIONS:The study was limited by the pragmatic approach necessary to evaluate the results in routine clinical practice.
CONCLUSIONS:This study shows that sacral nerve stimulation has limited efficacy on an intention-to-treat basis as a routinely recommended therapy for intractable idiopathic constipation.