Sacral Nerve Stimulation in Children with Medically Refractory Fecal Incontinence or Severe Constipation |
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Institution: | 1. Colorectal Center at Cincinnati Children''s, Division of Pediatric General and Thoracic Surgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;2. Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN, USA;3. The Indiana University School of Medicine, Indianapolis, IN, USA;4. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA |
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Abstract: | IntroductionThe goal of this study was to evaluate outcomes in patients treated with sacral nerve stimulation (SNS) for medically refractory fecal incontinence or severe constipation.MethodsWe performed a retrospective cohort study of all patients treated with SNS after failed medical management at a single center between 9/1/2015 and 6/30/2022. Demographic and clinical data was extracted from the electronic medical record. Rates of involuntary bowel movements were evaluated using a bowel severity score questionnaire and compared pre- and post-SNS using McNemar and McNemar–Bowker tests.Results70 patients underwent SNS placement. The median age was 12.8 years (IQR 8.6–16.0) and 61.4% were male. The most common diagnosis was idiopathic constipation (67.1%), followed by anorectal malformation (15.7%), and others. 43 patients had severity scores recorded both pre- and at least 90 days post-SNS insertion. The rates of daytime and nighttime involuntary bowel movements were significantly different pre-compared to post-SNS placement (p = 0.038 and p = 0.049, respectively). The rate of daytime and nighttime fecal continence increased from 44% to 58.1% and 53.5%–83.7%, respectively. The rate of at least weekly daytime and nighttime fecal incontinence decreased from 48.8% to 18.7% and 34.9%–7.0%, respectively. Minor pain/neurological symptoms occurred in 40% of patients, while 5.7% developed a wound infection. Further surgery for the SNS was required in 40% of patients.ConclusionsSNS placement can be an effective treatment for medically refractory fecal incontinence. Minor complications and the need for further procedures are common, while more serious complications like wound infections are rare.Type of StudyRetrospective Cohort Study.Level of EvidenceLevel 3. |
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Keywords: | Fecal incontinence Constipation Sacral nerve stimulation Sacral nerve modulation DOB"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"Date of Birth IQR"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"Inter-Quartile Range PFISS"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"Pediatric Fecal Incontinence Severity Score questionnaire SNS"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"Sacral Nerve Stimulation SSI"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"Surgical Site Infections |
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