Sacral Nerve Stimulation for Fecal Incontinence: External Anal Sphincter Defect <Emphasis Type="Italic">vs</Emphasis>. Intact Anal Sphincter |
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Authors: | Miranda K Y Chan Joe J Tjandra |
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Institution: | (1) Department of Colorectal Surgery, Epworth Hospital, University of Melbourne, Melbourne, Australia;(2) Department of Surgery, Caritas Medical Centre, 111, Wing Hong Street, Shum Shui Po, Kowloon, Hong Kong |
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Abstract: | Purpose This prospective study was designed to assess the effectiveness of sacral nerve stimulation for fecal incontinence in patients
with external anal sphincter defect and to evaluate its efficacy regarding presence and size of sphincter defect.
Methods Fifty-three consecutive patients who underwent sacral nerve stimulation for fecal incontinence were divided into two groups:
external anal sphincter defect group (n = 21) vs. intact sphincter group (n = 32). Follow-up was performed at 3, 6, and 12 months with anorectal physiology, Wexner’s score,
bowel diary, and quality of life questionnaires.
Results The external anal sphincter defect group (defect <90°:defect 90°–120° = 11:10) and intact sphincter group were comparable
with regard to age (mean, 63 vs. 63.6) and sex. Incidence of internal anal sphincter defect and pudendal neuropathy was similar. All 53 patients benefited
from sacral nerve stimulation. Weekly incontinent episodes decreased from 13.8 to 5 (P < 0.0001) for patients with external anal sphincter defects and from 6.7 to 2 (P = 0.001) for patients with intact sphincter at 12-month follow-up. Quality of life scores improved in both groups (P < 0.0125). There was no significant difference in improvement in functional outcomes after sacral nerve stimulation between
patients with or without external anal sphincter defects. Clinical benefit of sacral nerve stimulation was similar among patients
with external anal sphincter defects, irrespective of its size. Presence of pudendal neuropathy did not affect outcome of
neurostimulation.
Conclusions Sacral nerve stimulation for fecal incontinence is as effective in patients with external anal sphincter defects as those
with intact sphincter and the result is similar for defect size up to 120° of circumference.
†Deceased. |
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Keywords: | Sacral nerve stimulation External anal sphincter defect Fecal incontinence |
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