[Indications and results of sacral nerve stimulation in faecal incontinence].
BACKGROUND
Sacral nerve stimulation (SNS) is an effective and less invasive treatment of faecal incontinence (FI). Patient selection has evolved from strict criteria to a more liberal approach, since temporary testing reliably predicts the efficacy of permanent stimulation in FI of various aetiologies.


METHODS
From November 2005 until June 2007, we evaluated 20 consecutive patients (17 females, 3 males) with FI by percutaneous nerve evaluation (PNE), i. e., temporary stimulation. 13 patients proceeded to a permanent implantation of a pulse generator (3 bilateral generators). 11 patients with permanent stimulation were eligible for a minimum follow-up of 3 months. Median follow-up for this group was 10 (range 3-19) months. All patients provided bowel diaries, the disease-specific quality of life questionnaire of the American Society of Colon and Rectal Surgeons (ASCRS), and the Standard Short Form Health Survey Questionnaire (SF-36) at baseline, screening and at the follow-up.


RESULTS
The aetiologies of the FI were pelvic floor insufficiency (n = 12), history of anterior resection (n = 3), history of surgery for disk prolaps (n = 2), sphincter disruption (n = 1), history of surgery for recto-vaginal fistula (n = 1), and idiopathic (n = 1). The mean number of incontinence episodes dropped from 9.9 to 1.3 during temporary testing (p = 0.02) and to 4.5 at last follow-up (p = 0.043). The quality of life assessment showed a significant improvement in the subscale embarrassment of the ASCRS (p = 0.043). There were 2 minor postoperative complications, and 1 medium-term failure of SNS treatment.


CONCLUSIONS
SNS is a minimally invasive and effective treatment of FI. A pragmatic approach is justified due to the possibility of temporary testing and the low rate of complications.
Stelzner
S
S
Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Dresden-Friedrichstadt, Akademisches Lehrkrankenhaus der Technischen Universität Dresden. Stelzner-Si@khdf.de
Köhler
K
K
Hellmich
G
G
Witzigmann
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome