Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction.
METHODS
Long-term follow-up study.


OBJECTIVE
Short-term results find transanal colonic irrigation (TAI) favourable in the treatment of neurogenic bowel dysfunction (NBD). Therefore, long-term results need to be described.


METHODS
Department of Surgery P, Aarhus University Hospital, Denmark.


METHODS
Between 1994 and 2007, 211 (115 female) patients with NBD (age: 7-81 years (median 49)) were introduced to TAI. One hundred and seventy-three patients had spinal cord injury and 38 had other neurological disorders. Data were obtained from hospital records and a mailed questionnaire. Treatment was considered successful in patients still using TAI, patients who had used TAI until they died and patients whose symptoms had resolved while using TAI.


RESULTS
Successful outcome was achieved in 98 (46%) patients after a mean follow-up of 19 months (range 1-114 months). A Kaplan-Meier plot showed a dropout of 20% in the first 3 months. After 3 years, the rate of success was 35% and remained almost unchanged afterwards. A regression analysis showed male gender (odds ratio (OR) 2.1), mixed symptoms (OR 2.9) and prolonged colorectal transit time (OR 2.4) to be significantly associated with successful outcome. One non-lethal bowel perforation occurred in approximately 50,000 irrigations (0.002%), whereas minor side effects were observed in 48%.


CONCLUSIONS
After a mean follow-up of 19 months, 46% was successfully treated. The rate of success was 35% after 3 years and remained almost unchanged afterwards. TAI is safe and can be introduced to most patients suffering from NBD.
Faaborg
P M
PM
Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark. pmfaaborg@gmail.com
Christensen
P
P
Kvitsau
B
B
Buntzen
S
S
Laurberg
S
S
Krogh
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004733:Enema / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000209:etiology* / Q000628:therapy*; D016017:Odds Ratio; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult