Functional outcome of sacral nerve stimulation in patients with severe constipation.
BACKGROUND
Sacral nerve stimulation has been reported as an effective treatment for constipation.


OBJECTIVE
This study aimed to evaluate the therapeutic efficacy of permanent sacral nerve stimulation on the treatment of idiopathic constipation resistant to medical and behavioral management over a median follow-up period of 25.6 (range, 6-96) months.


METHODS
A retrospective review of a prospectively maintained institutional review board-approved database was performed.


METHODS
The study was performed at 2 tertiary-care European institutions with expertise in sacral nerve stimulation.


METHODS
Patients were considered eligible if they had had symptoms for at least 1 year and if conservative treatment had failed.


METHODS
Patients were tested by percutaneous nerve evaluation before the procedure. If this evaluation was successful, patients underwent sacral nerve therapy with an implanted device.


METHODS
Patients were evaluated by means of a bowel function diary and the Wexner constipation score.


RESULTS
A total of 48 consecutive patients (39 females, median age 50.0 years (range, 17-79 years) entered the study. Twenty-three patients were implanted with a permanent stimulator. On an intention-to-treat basis, only 14 of 48 patients (29.2%) met the definition of a successful outcome at the latest follow-up period (median, 25.6 (range, 6-96) months). The mean Wexner score decreased from 20.2 (SD 3.6) at baseline to 5.8 (SD 4.1) at the latest follow-up examination (p < 0.001). However, 6 of 14 patients (42.8%) were still using laxatives and/or enemas at the last follow-up.


CONCLUSIONS
The study was limited by the pragmatic approach necessary to evaluate the results in routine clinical practice.


CONCLUSIONS
This study shows that sacral nerve stimulation has limited efficacy on an intention-to-treat basis as a routinely recommended therapy for intractable idiopathic constipation.
Department of Surgery, Virgen del Camino Hospital, Universidad Pública de Navarra, Pamplona, Navarra, Spain. hhortiz@telefonica.net
Héctor
H
Ortiz
Mario
M
de Miguel
Marcella
M
Rinaldi
Fabiola
F
Oteiza
Donato F
DF
Altomare
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058542:Implantable Neurostimulators; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult