title: Sacral nerve stimulation allows for decreased antegrade continence enema use in children with severe constipation.
abstract: BACKGROUND
  Sacral nerve stimulation (SNS) can be beneficial for children with constipation, but no studies have focused on children with constipation severe enough to require antegrade continence enemas (ACEs). Our objective was to evaluate the efficacy of SNS in children with constipation treated with ACE.
  
  
  METHODS
  Using a prospective patient registry, we identified patients <21years old who were receiving ACE prior to SNS placement. We compared ACE/laxative usage, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), Fecal Incontinence Severity Index (FISI), and Vancouver Dysfunctional Elimination Syndrome Score (DES) at baseline and progressive follow-up time intervals.
  
  
  RESULTS
  Twenty-two patients (55% male, median 12years) were included. Median ACE frequency decreased from 7 per week at baseline to 1 per week at 12months (p<0.0001). Ten children (45%) had their cecostomy/appendicostomy closed. Laxative use, GSS, FIQL, and DES did not change. FISI improved over the first 12months with statistical significance reached only at 6months (p=0.02). Six (27%) children experienced complications after SNS that required further surgery.
  
  
  CONCLUSIONS
  In children with severe constipation dependent on ACE, SNS led to a steady decrease in ACE usage with nearly half of patients receiving cecostomy/appendicostomy closure within 2years.
  
  
  METHODS
  IV.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address: peter.lu@nationwidechildrens.org.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lu
authors.affiliation: Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Asti
authors.affiliation: Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Lodwick
authors.affiliation: Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Nacion
authors.affiliation: Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Department of Pediatric Surgery, Levine Children's Hospital, Charlotte, NC 28204, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Teich
authors.affiliation: Division of Urology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Alpert
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Desale
authors.initials: D
authors.lastname: Yacob
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA.
authors.forename: Hayat M
authors.initials: HM
authors.lastname: Mousa
mesh_terms: D000293:Adolescent; D002431:Cecostomy; D002648:Child; D003248:Constipation / Q000150:complications / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012445:Sacrococcygeal Region / Q000294:innervation*; D013127:Spinal Nerves; D016896:Treatment Outcome; D055815:Young Adult
keywords: Appendicostomy; Cecostomy; Electrical stimulation; Fecal incontinence; Neuromodulation; Neurostimulation