Sacral Neuromodulation: Does It Affect the Rectoanal Angle in Patients with Fecal Incontinence?

• Published in: World journal of surgery Vol. 34; no. 5; pp. 1109 - 1114
• Main Authors: Uludağ, Ö., Koch, S. M. P., Vliegen, R. F., Dejong, C. H. C., van Gemert, W. G., Baeten, C. G. M. I.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-05-2010; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Anal Canal - diagnostic imaging; Biological and medical sciences; Cardiac Surgery; Defecography; Electric Stimulation Therapy; Electrodes, Implanted; Fecal incontinence; Fecal Incontinence - diagnostic imaging; Fecal Incontinence - therapy; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; General Surgery; Humans; Lumbosacral Plexus; Male; Manometry; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Other diseases. Semiology; Radiography; Rectum - diagnostic imaging; Sacral nerve stimulation; Sacral neuromodulation; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Thoracic Surgery; Vascular Surgery; Fecal incontinence; Defecography; Sacral nerve stimulation; Sacral neuromodulation; Human; Medicine; Sacrum; Treatment; Surgery; Digestive diseases; Intestinal disease; Anal incontinence; Patient; Neuromodulation; Anorectal disease
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0474-8

Background
In the past decade numerous studies have been published on the successful treatment of fecal incontinence with sacral neuromodulation (SNM). The underlying mechanism of action for lower bowel motility disorders has been unclear. In the present study, the effect of SNM on the rectoanal angle in patients with fecal incontinence was investigated.
Patients and Methods
In 12 consecutive patients who qualified for SNM an X-defecography study was performed before SNM and at 6 months after permanent implant. Three single lateral rectal views were taken: one during rest, one during squeeze, and one during Valsalva’s maneuver, after which the patient was asked to evacuate as rapidly and completely as possible during lateral fluoroscopy. At 6 months two further defecography studies were performed, one during stimulation with the pacemaker on and one with the pacemaker off.
Results
The defecography studies showed that the rectoanal angle decreased during rest, squeeze, and Valsalva’s maneuver. A slight increase in rectoanal angle was seen during defecation. However, the differences did not reach statistical significance. Sacral neuromodulation improved fecal continence significantly in all patients at 6 months. Median incontinence episodes per week decreased from 6.2 to 1.0 (
P
 = 0.001), and incontinent days per week decreased from 3.7 to 1.0 (
P
 = 0.001) with SNM. There were no significant changes in the median resting and squeeze anal canal pressures, 46.5 versus 49.7 mmHg and 67.1 versus 72.3 mmHg, respectively. Median stimulation amplitude at follow-up was 2.7 V (range: 0.9–5.3 V).
Conclusions
Rectoanal angle did not decrease significantly in patients with fecal incontinence during SNM.