Sacral neuromodulation in the treatment of severe anal incontinence. Forty consecutive cases treated in one institution.
BACKGROUND
Sacral neuromodulation is a recognized therapeutic option in severe anal incontinence from neurogenic origins, when medical treatment has failed.


METHODS
We report the results of this procedure applied in 40 consecutive patients operated on by a single surgeon from August 2001 to June 2004. Mean duration of incontinence was 5 years. There were 33 women and 7 men of mean age 59 (range 29-89). All patients had had medical treatment, 26 had had physiotherapy and 9 had been previously operated on for that problem. Neuromodulation consisted in a temporary electrical stimulation test followed by implantation of a stimulator in case of efficacy.


RESULTS
Twenty nine patients had a positive test and were implanted. Ten had a negative test and one is waiting for implantation. From the 29 patients, 23 had uneventful postoperative course. Incontinence score varied from 17 before neuromodulation to 6 after in the 24 patients who were improved. Mean resting pressure, mean maximum squeeze pressure and mean duration of squeeze pressure did not change from pre to postoperative period.


CONCLUSIONS
Sacral neuromodulation is a safe and efficacious procedure in properly selected anal incontinent patients. However, we observed no correlation between clinical and manometric data.
Faucheron
Jean-Luc
JL
Unité de Chirurgie Colorectale, Département de Chirurgie Digestive et de l'Urgence, Hôpital Albert Michallon, Grenoble. JLFaucheron@chu-grenoble.fr
Bost
Richard
R
Duffournet
Virginie
V
Dupuy
Simon
S
Cardin
Nicolas
N
Bonaz
Bruno
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012445:Sacrococcygeal Region / Q000294:innervation*; D016896:Treatment Outcome