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Long‐term results following sacral nerve stimulation for chronic constipation
Author(s) -
Ratto C.,
Ganio E.,
Naldini G.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12857
Subject(s) - medicine , constipation , sacral nerve stimulation , chronic constipation , functional constipation , anorectal manometry , implant , surgery
Aim The long‐term outcome of sacral nerve stimulation ( SNS ) for chronic functional constipation was assessed. Method Patients who received a definitive SNS implant for chronic functional constipation only (according to the Rome III criteria) and were followed up for at least 3 years were included in this study. Slow transit constipation ( STC ) was distinguished from obstructed defaecation ( OD ) and mixed/undetermined constipation ( MU ). Constipation features, Cleveland Clinic Constipation score ( CCCS ) and SF ‐36 questionnaire data were collected; physiological tests were performed. Results Forty‐two out of 61 patients suitable for SNS received a definitive implant (14 for STC , 15 for OD , 13 for MU ). Following SNS device implantation (mean follow‐up 51 ± 15 months), the baseline CCCS (17 ± 6) dropped to 9 ± 6 ( P < 0.001) and 47% of patients had an improvement in the CCCS of more than 50%. Such improvement was more significant in patients with OD . Anal pressures did not change, while threshold and urgency rectal sensation significantly decreased, in particular in patients with OD . All aspects of patients' health status ( SF ‐36) improved significantly following SNS ; this was more marked in patients with OD . Conclusion Data from this study suggest that the clinical efficacy of SNS can be prolonged in constipated patients, but in both the preliminary diagnostic assessment and pathophysiological interpretation every effort should be made to select patients for SNS . Although SNS showed efficacy in a low percentage of patients with STC , patients with OD were more responsive.