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01-05-2005 | Original Contribution

Sacral Neuromodulation in Treatment of Fecal Incontinence Following Anterior Resection and Chemoradiation for Rectal Cancer

Authors: Carlo Ratto, M.D., Egizia Grillo, M.D., Angelo Parello, M.D., Maria Petrolino, M.D., Guido Costamagna, M.D., Giovanni B. Doglietto, M.D.

Published in: Diseases of the Colon & Rectum | Issue 5/2005

PURPOSE

Fecal incontinence may occur in patients who have undergone anterior resection for rectal cancer without presenting sphincter lesions. Chemoradiation may contribute to disrupting continence mechanisms. Treatment is controversial. Assessment of fecal incontinence in patients who agreed to integrate treatment for rectal cancer and treatment with sacral neuromodulation are reported.

METHODS

Fecal incontinence following preoperative chemoradiation and anterior resection for rectal cancer was evaluated in four patients. A good response was observed during the percutaneous sacral nerve evaluation test, and so permanent implant of sacral neuromodulation system was performed. Reevaluation was performed at least two months after implant.

RESULTS

After device implantation, the mean fecal incontinence scores decreased, and the mean number of incontinence episodes dropped from 12.0 to 2.5 per week (P < 0.05). Permanent implant resulted in a significant improvement in fecal continence in three patients, and incontinence was slightly reduced in the fourth. Manometric parameters agreed with clinical results: maximum and mean resting tone and the squeeze pressure were normal in three patients and reduced in one. In these same three patients, neorectal sensation parameters increased when the preoperative value was normal or below normal and decreased when the preoperative value was higher than normal, whereas in one patient in whom extremely low values were recorded all of the parameters decreased significantly.

CONCLUSIONS

Fecal incontinence following anterior resection and neoadjuvant therapy should be carefully evaluated. If a suspected neurogenic pathogenesis is confirmed, sacral neuromodulation may be proposed. If the test results are positive, permanent implant is advisable. Failure of this approach does not exclude the use of other, more aggressive treatment.

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Title: Sacral Neuromodulation in Treatment of Fecal Incontinence Following Anterior Resection and Chemoradiation for Rectal Cancer
Authors: Carlo Ratto, M.D.
Egizia Grillo, M.D.
Angelo Parello, M.D.
Maria Petrolino, M.D.
Guido Costamagna, M.D.
Giovanni B. Doglietto, M.D.
Publication date: 01-05-2005
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 5/2005
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-004-0884-5

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Sacral Neuromodulation in Treatment of Fecal Incontinence Following Anterior Resection and Chemoradiation for Rectal Cancer

PURPOSE

METHODS

RESULTS

CONCLUSIONS

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

PURPOSE

METHODS

RESULTS

CONCLUSIONS

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