This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Medium‐term results of permanent sacral nerve stimulation for faecal incontinence. BJS 2002; 89: 896-901.
Published: 5th November 2002
Authors: N. J. Kenefick, C. J. Vaizey, R. C. G. Cohen, R. J. Nicholls, M. A. Kamm
Background
Anal sphincter surgery for faecal incontinence is associated with significant morbidity and a variable outcome. Sacral nerve stimulation may provide a good functional outcome with minimal morbidity. This paper reports the experience in a single centre over 5 years.
Method
Fifteen consecutive patients (14 women), median age 60 (range 37–71) years, underwent temporary, and subsequent permanent, stimulation. All had incontinence to solid or liquid stool; the aetiology was obstetric injury (seven patients), scleroderma (four), idiopathic (two), fistula surgery (one) and repaired rectal prolapse (one). Median duration of symptoms was 6 (range 2–15) years. Clinical evaluation, endoanal ultrasonography, bowel diary, quality of life questionnaire (Short Form (SF) 36) and anorectal physiological testing were performed before and after stimulation.
Results
Continence had improved in all patients at median follow‐up of 24 (range 3–60) months. Eleven patients were fully continent. Episodes of faecal incontinence decreased from median (range) 11 (2–30) per week before stimulation to 0 (0–4) per week after permanent stimulation (P < 0·001). Urgency improved in all patients (median (range) ability to defer less than 1 (0–1) versus 8 (1–15) min; P = 0·01). ‘Social function’ and ‘role‐physical’ subscales of the SF36 improved significantly. Mean resting pressure (35 versus 49 cmH2O with temporary stimulation; P < 0·05) and squeeze pressure increment (43 versus 69 cmH2O with permanent stimulation; P < 0·01) increased. Rectal sensitivity to initial distension changed (mean 47 versus 34 ml air; P < 0·05). There were no major complications.
Conclusion
Sacral nerve stimulation is a safe and effective treatment for faecal incontinence when conventional treatment has failed. There is minimal morbidity. The benefit is maintained in the medium term. © 2002 British Journal of Surgery Society Ltd
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