Infection rates in a large investigational trial of sacral nerve stimulation for fecal incontinence.
BACKGROUND
Treatment options for patients with fecal incontinence (FI) are limited, and surgical treatments can be associated with high rates of infection and other complications. One treatment, sacral nerve stimulation (SNS), is approved for FI in Europe. A large multicenter trial was conducted in North America and Australia to assess the efficacy of SNS in patients with chronic fecal incontinence. The aim of this report was to analyze the infectious complication rates in that trial.


METHODS
Adult patients with a history of chronic fecal incontinence were enrolled into this study. Those patients who fulfilled study inclusion/exclusion criteria and demonstrated greater than two FI episodes per week underwent a 2-week test phase of SNS. Patients who showed a > or = 50% reduction in incontinent episodes and/or days per week underwent chronic stimulator implantation. Adverse events were reported to the sponsor by investigators at each study site and then coded. All events coded as implant site infection were included in this analysis.


RESULTS
One hundred twenty subjects (92% female, 60.5 +/- 12.5 years old) received a chronically implanted InterStim Therapy device (Medtronic, Minneapolis, MN, USA). Patients were followed for an average of 28 months (range 2.2-69.5). Thirteen of the 120 implanted subjects (10.8%) reported infection after the chronic system implant. One infection spontaneously resolved and five were successfully treated with antibiotics. Seven infections (5.8%) required surgical intervention, with infections in six patients requiring full permanent device explantation. The duration of the test stimulation implant procedure was similar between the infected group (74 min) and the non-infected group (74 min). The average duration of the chronic neurostimulator implant procedure was also similar between the infected (39 min) and non-infected group (37 min). Nine infections occurred within a month of chronic system implant and the remaining four infections occurred more than a year from implantation. While the majority (7/9) of the early infections was successfully treated with observation, antibiotics, or system replacement, all four of the late infections resulted in permanent system explantation.


CONCLUSIONS
SNS for FI resulted in a relatively low infection rate. This finding is especially important because the only other Food and Drug Administration-approved treatment for end-stage FI, the artificial bowel sphincter, reports a much higher rate. Combined with its published high therapeutic success rate, this treatment has a positive risk/benefit profile.
Wexner
Steven D
SD
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, FL, USA. wexners@ccf.org
Hull
Tracy
T
Edden
Yair
Y
Coller
John A
JA
Devroede
Ghislain
G
McCallum
Richard
R
Chan
Miranda
M
Ayscue
Jennifer M
JM
Shobeiri
Abbas S
AS
Margolin
David
D
England
Michael
M
Kaufman
Howard
H
Snape
William J
WJ
Mutlu
Ece
E
Chua
Heidi
H
Pettit
Paul
P
Nagle
Deborah
D
Madoff
Robert D
RD
Lerew
Darin R
DR
Mellgren
Anders
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000209:etiology*; D008160:Lumbosacral Plexus / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome