Success and Complication Rates After Sacral Neuromodulation for Fecal Incontinence and Constipation: A Single-center Follow-up Study
Widmann Bernhard, Galata Christian, Warschkow Rene, Beutner Ulrich, Ogredici Onder, Hetzer Franc H, Schmied Bruno M, Post Stefan, Marti Lukas,
소속 상세정보
( Widmann Bernhard )
Kantonsspital St. Gallen Department of General, Visceral, Endocrine and Transplantation Surgery
( Galata Christian )
University of Heidelberg University Medical Center Mannheim Department of Surgery
( Warschkow Rene )
Kantonsspital St. Gallen Department of General, Visceral, Endocrine and Transplantation Surgery
( Beutner Ulrich )
Kantonsspital St. Gallen Department of General, Visceral, Endocrine and Transplantation Surgery
( Ogredici Onder )
Kantonsspital St. Gallen Department of General, Visceral, Endocrine and Transplantation Surgery
( Hetzer Franc H )
Spital Linth Department of Surgery
( Schmied Bruno M )
Kantonsspital St. Gallen Department of General, Visceral, Endocrine and Transplantation Surgery
( Post Stefan )
University of Heidelberg University Medical Center Mannheim Department of Surgery
( Marti Lukas )
Kantonsspital St. Gallen Department of General, Visceral, Endocrine and Transplantation Surgery
Abstract
Background/Aims: The aim of this study was to evaluate the sustainability of sacral neuromodulation (SNM) success in patients with fecal incontinence (FI) and/or constipation.
Methods: This is a retrospective analysis of a prospective database of patients who received SNM therapy for FI and/or constipation between 2006 and 2015. Success rates, complications and reintervention rates were assessed after up to 10 years of follow-up.
Results: Electrodes for test stimulation were implanted in 101 patients, of whom 79 (78.2%) received permanent stimulation. The mean follow-up was 4.4 ± 3.0 years. At the end of follow-up, 57 patients (72.2%) were still receiving SNM. The 5-year success rate for FI and isolated constipation was 88.2% (95% confidence interval [CI], 80.1?97.0%) and 31.2% (95% CI, 10.2?95.5%), respectively (P < 0.001). In patients with FI, involuntary evacuations per week decreased > 50% in 76.1% of patients (95% CI, 67.6?86.2%) after 5 years. A lead position at S3 was associated with an improved outcome (P = 0.04). Battery exchange was necessary in 23 patients (29.1%), with a median battery life of 6.2 years. Reinterventions due to complications were necessary in 24 patients (30.4%). For these patients, the 5-year success rate was 89.0% (95% CI, 75.3?100.0%) compared to 78.4% (95% CI, 67.2?91.4%) for patients without reintervention.
Conclusions: SNM offers an effective sustainable treatment for FI. For constipation, lasting success of SNM is limited and is thus not recommended. Reinterventions are necessary but do not impede treatment success.
키워드
Constipation; Electric stimulation; Fecal incontinence; Sacral nerve stimulation; Sacral neuromodulation
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