title: Outcomes of Sacral Neurostimulation Lead Reimplantation for Fecal Incontinence: A Cohort Study.
abstract: BACKGROUND
  Adverse events and complications have been reported after sacral neurostimulation for fecal incontinence, which may result in surgical revision and device explantation. Lead reimplantation may be feasible; however, available data regarding outcomes are less robust.
  
  
  OBJECTIVE
  The aim of this study was to determine the outcomes of sacral neurostimulation lead reimplantation for fecal incontinence.
  
  
  METHODS
  This was a retrospective review of prospectively collected data.
  
  
  METHODS
  The study was conducted at 2 clinical sites from a single institution.
  
  
  METHODS
  Patients with fecal incontinence who underwent sacral neurostimulation implantation or reimplantation between 2011 and 2014 were included in the study.
  
  
  METHODS
  Sacral neurostimulation reimplantation was the included intervention.
  
  
  METHODS
  Change in the Cleveland Clinic Florida Fecal Incontinence Score (0 best; 20 worst) in reimplantation as compared with index implantation controls was the main measure. Secondary outcomes included the frequency and type of adverse events and complications.
  
  
  RESULTS
  A total of 112 patients underwent either sacral neurostimulation implantation or reimplantation between 2011 and 2014. Ninety-seven patients underwent an index percutaneous nerve stimulation trial, 93 of whom also underwent a stimulator implantation. Fifteen patients underwent lead reimplantation, with 5 performed before stimulator implantation and 10 after stimulator implantation. The index implanted and reimplanted groups had similar demographics, comorbidities, and complication profiles including explantation rates. The most common reason for reimplantation was lead related (6/15), including 4 lead migrations, 1 lead fracture, and 1 lead erosion. Significant decreases in the incontinence score were achieved in each group (index implantation: p < 0.001; reimplantation: p = 0.006). When comparing the efficacy of sacral neurostimulation therapy in decreasing the fecal incontinence score from baseline in each group, patients with an index implantation were found to have a more significant improvement in their incontinence score as compared with the reimplantation group (p = 0.047).
  
  
  CONCLUSIONS
  This was a retrospective study. A large number of patients with incomplete functional assessment data were excluded from analysis.
  
  
  CONCLUSIONS
  The improvements in fecal incontinence are significantly better after index implantation than after reimplantation.
authors.affiliation: 1 Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 2 Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Cracco
authors.forename: Sami A
authors.initials: SA
authors.lastname: Chadi
authors.forename: Fábio G
authors.initials: FG
authors.lastname: Rodrigues
authors.forename: Massarat
authors.initials: M
authors.lastname: Zutshi
authors.forename: Brooke
authors.initials: B
authors.lastname: Gurland
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.forename: Giovanna
authors.initials: G
authors.lastname: DaSilva