Results after sacral nerve stimulation for chronic constipation

• Published in: Neurogastroenterology and motility Vol. 27; no. 5; pp. 734 - 739
• Main Authors: Graf, W., Sonesson, A.‐C., Lindberg, B., Åkerud, P., Karlbom, U.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-05-2015
• Subjects: Adult; Aged; Chronic Disease; Cohort Studies; constipation; Constipation - therapy; Electric Stimulation Therapy - methods; Electrodes, Implanted; Female; Humans; Lumbosacral Plexus; Male; Middle Aged; outlet obstruction; sacral nerve stimulation; slow transit constipation; Treatment Outcome; Young Adult; constipation; outlet obstruction; slow transit constipation; sacral nerve stimulation
• ISSN: 1350-1925; 1365-2982; 1365-2982
• DOI: 10.1111/nmo.12546

Background
Sacral nerve stimulation is an established treatment for fecal incontinence and initial reports describe successful results also in subjects with chronic constipation.
Methods
Consecutive patients with slow transit or outlet obstruction type constipation were offered external stimulation through a test electrode inserted in a sacral foramen during a 3‐week period. The symptomatic evaluation was based on the number of bowel movements and a validated obstructed defecation score (ODS). A permanent implant was performed provided an overall 50% decrease in symptoms was observed.
Key Results
In total, 44 patients with chronic constipation were treated with a 3‐week test stimulation. Fifteen experienced a 50% reduction of symptoms and received a permanent implant. Four of the 15 with permanent implants were explanted during the course of the study. Five subjects (11% of original group) reported sustained symptom relief at final follow‐up after a mean of 24 months (range 4–81). Mean ODS score did not change during the treatment. Patients with predominantly slow transit constipation or outlet obstruction did not differ concerning success rate.
Conclusions & Inferences
Sacral nerve stimulation has limited efficacy in unselected patients with chronic constipation and cannot be recommended for treatment on routine basis.
Forty‐four patients with chronic constipation underwent temporary sacral nerve test stimulation of whom 15 received permanent implantation. Long‐lasting benefit at final follow‐up was seen in five patients (11%).