Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Techniques in Coloproctology
Published in: Techniques in Coloproctology 6/2019

01-06-2019 | Fecal Incontinence | Original Article

Sacral neuromodulation for fecal incontinence in Latin America: initial results of a multicenter study

Authors: L. Oliveira, G. Hagerman, M. L. Torres, C. M. Lumi, J. A. C. Siachoque, J. C. Reyes, J. Perez-Aguirre, J. C. Sanchez-Robles, V. H. Guerrero-Guerrero, S. M. Regadas, V. G. Filho, G. Rosato, E. Vieira, L. Marzan, D. Lima, E. Londoño-Schimmer, S. D. Wexner

Published in: Techniques in Coloproctology | Issue 6/2019

Login to get access

Abstract

Background

Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America.

Methods

A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1–84) months.

Results

One hundred and thirty-one patients [119 females, median age of 62.2 (range 19–87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1–84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as “significant”.

Conclusions

Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.
Literature
1.
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911CrossRefPubMed
2.
Damon H, Henry L, Bretones S et al (2000) Postdelivery anal function in primiparous females: ultrasound and manometric study. Dis Colon Rectum 43:472–477CrossRefPubMed
3.
Karoui S, Savoye-Collet C, Koning E et al (1999) Prevalence of anal sphincter defects revealed by sonography in 335 incontinent patients and 115 continent patients. Am J Roentgenol 1173:389–392CrossRef
4.
Dudding TC, Vaizey CJ, Kamm MA (2008) Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 247(2):224–237CrossRefPubMed
5.
Ng KS, Sivakumaran Y, Nassar N, Gladman MA (2015) Fecal Incontinence: community Prevalence and Associated Factors-A Systematic Review. Dis Colon Rectum 58(12):1194–1209CrossRefPubMed
6.
Bharucha AE, Zinsmeister AR, Locke GR et al (2006) Symptoms and quality of life in community women with fecal incontinence. Clin Gastroenterol Hepatol 4:1004–1009CrossRefPubMed
7.
Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91:33–36PubMed
8.
9.
Van Koughnett JM, Wexner SD (2013) Current management of fecal incontinence: choosing amongst treatment options to optimize outcomes. World J Gastroenterol 19(48):9216–9230CrossRefPubMedPubMedCentral
10.
Wexner SD (2015) Percutaneous tibial nerve stimulation in faecal incontinence. Lancet 386(10004):1605–1606CrossRefPubMed
11.
Oliveira L, Pfeifer J, Wexner SD (1996) Physiological and clinical outcome of anterior sphincteroplasty. Br J Surg 83:1244–1251CrossRef
12.
Rongen MJ, Uludag O, El Naggar K et al (2003) Long-term follow-up of dynamic graciloplasty for fecal incontinence. Dis Colon Rectum 46:716–721CrossRefPubMed
13.
Madoff RD, Baeten CG, Christiansen J et al (2000) Standards for anal sphincter replacement. Dis Colon Rectum 43:135–141CrossRefPubMed
14.
Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97CrossRef
15.
Matzel KE, Stadelmaier U, Hohenberger W (2004) Innovations in fecal incontinence: sacral nerve stimulation. Dis Colon Rectum 47:1720–1728CrossRefPubMed
16.
Boyle DJ, Knowles CH, Lunniss PJ et al (2009) Efficacy of sacral nerve stimulation for fecal incontinence in patients with anal sphincter defects. Dis Colon Rectum 52:1234–1239CrossRefPubMed
17.
Altomare DF, Giuratrabocchetta S, Knowles CH et al (2015) Long-term outcomes of sacral nerve stimulation for faecal incontinence. Br J Surg 102:407–415CrossRefPubMed
18.
Hull T, Giese C, Wexner SD et al (2013) Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum 56:234–245CrossRefPubMed
19.
Mellgren A, Wexner SD, Coller JA, SNS Study Group et al (2011) Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 54:1065–1075CrossRefPubMed
20.
Dudding TC, Meng Lee E, Faiz O et al (2008) Economic evaluation of sacral nerve stimulation for faecal incontinence. Br J Surg 95:1155–1163CrossRefPubMed
Metadata
Title
Sacral neuromodulation for fecal incontinence in Latin America: initial results of a multicenter study
Authors
L. Oliveira
G. Hagerman
M. L. Torres
C. M. Lumi
J. A. C. Siachoque
J. C. Reyes
J. Perez-Aguirre
J. C. Sanchez-Robles
V. H. Guerrero-Guerrero
S. M. Regadas
V. G. Filho
G. Rosato
E. Vieira
L. Marzan
D. Lima
E. Londoño-Schimmer
S. D. Wexner
Publication date
01-06-2019
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 6/2019
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-019-02004-y

Other articles of this Issue 6/2019

Techniques in Coloproctology 6/2019 Go to the issue

Technical Note

Robotic excision of a colonic neoplasm with ICG as a tumor localizer and colonoscopic assistance

Correspondence

The Kraske procedure: no more indications for benign lesions?

Correction

Correction to: Progression of anal intraepithelial neoplasia in HIV-positive individuals: predisposing factors

Technical Advances

Optimized fistulectomy using the novel FiXcision® device: a technical feasibility study and evaluation of short term healing rates

Original Article

Practice parameters for the diagnosis and treatment of anal intraepithelial neoplasia (AIN) on behalf of the Italian Society of Colorectal Surgery (SICCR)

Correspondence

An unusual rectal obstruction