title: Sacral neuromodulation for the treatment of faecal incontinence following proctectomy.
abstract: OBJECTIVE
  This study assessed the effectiveness of sacral neuromodulation (SNM) for faecal incontinence (FI) following proctectomy with colorectal or coloanal anastomosis.
  
  
  METHODS
  An Institutional Review Board (IRB)-approved database identified patients treated for FI following proctectomy (SNM-P) for benign or malignant disease, who were matched 1:1 according to preoperative Cleveland Clinic Florida Faecal Incontinence Scores (CCF-FIS) with patients without proctectomy (SNM-NP). Primary outcome was change in CCF-FIS.
  
  
  RESULTS
  Twelve patients (seven women) were in the SNM-P group and 12 (all women) were in the SNM-NP group. In the SNM-P group, six patients underwent proctectomy for low rectal cancer and five received neoadjuvant chemoradiation. Five patients had handsewn anastomosis, and one had stapled coloanal anastomosis. One lead explantation occurred after a failed 2-week SNM percutaneous trial. Six patients underwent proctectomy for benign conditions. Within-group analyses revealed significant improvement in CCF-FIS in the SNM-P group (reduction from a score of 18 to a score of 14; P = 0.02), which was more profound for benign disease (reduction from 14.5 to 8.5) than for rectal cancer (reduction from 19.5 to 15). SNM was explanted in 66% and 33% of patients after proctectomy for malignant and benign conditions, respectively. In the SNM-NP group, 41% underwent overlapping sphincteroplasty. One patient received chemoradiation for anal cancer. Within-group analysis for the SNM-NP group showed significant improvement in CCF-FIS (a reduction from 17.5 to 4.0; P = 0.003). There was significant improvement in CCF-FIS in patients without previous proctectomy (mean delta CCF-FIS: 11.1 vs 4.7; P = 0.011). Analysis of covariance (ANCOVA) reaffirmed that controls outperformed proctectomy patients (P = 0.006).
  
  
  CONCLUSIONS
  SNM for FI after proctectomy appears less effective than SNM in patients without proctectomy, with high device explantation rates, particularly after neoadjuvant chemoradiation and proctectomy for low rectal cancer.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: I
authors.initials: I
authors.lastname: Mizrahi
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Chadi
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: N
authors.initials: N
authors.lastname: Haim
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Sands
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: B
authors.initials: B
authors.lastname: Gurland
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: M
authors.initials: M
authors.lastname: Zutshi
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: G
authors.initials: G
authors.lastname: da Silva
mesh_terms: D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000628:therapy; D012189:Retrospective Studies; D012447:Sacrum / Q000294:innervation; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Sacral nerve stimulation; chemoradiation; faecal incontinence; low rectal cancer; proctectomy