Sacral Nerve Stimulation in Patients After Rectal Resection--preliminary Report

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2008 Feb 19

PMID 18278538

Citations 15

Authors

Brigitte Holzer

Harald R Rosen

Wolfgang Zaglmaier

Reinhold Klug

Bernhard Beer

Gabriele Novi

Rudolf Schiessel

Affiliations

Soon will be listed here.

Abstract

Introduction: Sacral nerve stimulation is a widely accepted therapeutic option for neurogenic fecal incontinence. More recently, case reports showed a positive effect of sacral nerve stimulation in patients with fecal incontinence following low anterior resection. The purpose of this study was to gain more information for this selected indication for sacral nerve stimulation through a nationwide survey.

Material And Methods: In the period 2002 to 2005, three Austrian departments reported data of patients who underwent SNS for fecal incontinence following rectal resection. Data were available of seven patients (two female, five male) with a median age of 57 years (min 42; max 79). Six patients had undergone rectal resection as a treatment for low rectal cancer. One patient had undergone rectal resection for Crohn's disease, one patient subtotal colectomy and ileorectostomy for slow colon transit constipation.

Results: Test stimulation was performed in the foramen S3 unilaterally over a median period of 14 days (2-21 days). Seven patients reported a marked reduction of episodes of incontinence during the observation period and received a permanent stimulation system. After a median follow-up of 32 months (17-46), five patients reported a marked improvement of their continence situation.

Conclusion: Despite a nationwide survey experiences with SNS as a treatment for fecal incontinence following rectal resection is still limited. Our observations show an improvement of the continence function following SNS. However, the promising results of our series as well as others need further research and more clinical data by a larger number of patients in a prospective trial.

Citing Articles

Sacral neuromodulation for low anterior resection syndrome: current status-a systematic review and meta-analysis.

Pires M, Severo M, Lopes A, Neves S, Matzel K, Povo A Int J Colorectal Dis. 2023; 38(1):189.

PMID: 37428256 DOI: 10.1007/s00384-023-04485-8.

Optimising functional outcomes in rectal cancer surgery.

Nocera F, Angehrn F, von Flue M, Steinemann D Langenbecks Arch Surg. 2020; 406(2):233-250.

PMID: 32712705 PMC: 7936967. DOI: 10.1007/s00423-020-01937-5.

The efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome: a systematic review and meta-analysis.

Ram E, Meyer R, Carter D, Gutman M, Rosin D, Horesh N Tech Coloproctol. 2020; 24(8):803-815.

PMID: 32350733 DOI: 10.1007/s10151-020-02231-8.

Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up.

Schiano di Visconte M, Santoro G, Cracco N, Sarzo G, Bellio G, Brunner M Tech Coloproctol. 2018; 22(2):97-105.

PMID: 29313165 DOI: 10.1007/s10151-017-1745-2.

Treatment possibilities for low anterior resection syndrome: a review of the literature.

Dulskas A, Smolskas E, Kildusiene I, Samalavicius N Int J Colorectal Dis. 2018; 33(3):251-260.

PMID: 29313107 DOI: 10.1007/s00384-017-2954-x.

References

Horgan P, OConnell P, Shinkwin C, Kirwan W . Effect of anterior resection on anal sphincter function. Br J Surg. 1989; 76(8):783-6. DOI: 10.1002/bjs.1800760805. View

Schiessel R, Novi G, Holzer B, Rosen H, Renner K, Holbling N . Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2005; 48(10):1858-65. DOI: 10.1007/s10350-005-0134-5. View

Paty P, Enker W, Cohen A, Minsky B . Long-term functional results of coloanal anastomosis for rectal cancer. Am J Surg. 1994; 167(1):90-4; discussion 94-5. DOI: 10.1016/0002-9610(94)90058-2. View

Vaizey C, Kamm M, Turner I, Nicholls R, Woloszko J . Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut. 1999; 44(3):407-12. PMC: 1727421. DOI: 10.1136/gut.44.3.407. View

Ganio E, Masin A, Ratto C, Altomare D, Ripetti V, Clerico G . Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients: evaluation of a new option for anorectal functional disorders. Dis Colon Rectum. 2001; 44(9):1261-7. DOI: 10.1007/BF02234782. View

Stelzner F, Rodel R, Biersack H, Jaeger U, von Mallek D . [Proof of natural spontaneous activity of pelvic and anal musculature by combined positron emission therapy and computed tomography. Importance for diagnosis and therapy]. Chirurg. 2003; 74(9):834-8. DOI: 10.1007/s00104-003-0666-y. View

Ratto C, Grillo E, Parello A, Petrolino M, Costamagna G, Doglietto G . Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon Rectum. 2005; 48(5):1027-36. DOI: 10.1007/s10350-004-0884-5. View

Matzel K, Stadelmaier U, Hohenfellner M, Gall F . Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet. 1995; 346(8983):1124-7. DOI: 10.1016/s0140-6736(95)91799-3. View

HAUTEFEUILLE P, Valleur P, Perniceni T, Martin B, GALIAN A, Cherqui D . Functional and oncologic results after coloanal anastomosis for low rectal carcinoma. Ann Surg. 1988; 207(1):61-4. PMC: 1493248. DOI: 10.1097/00000658-198801000-00012. View

10.

Holzer B, Rosen H, Novi G, Ausch C, Holbling N, Schiessel R . Sacral nerve stimulation for neurogenic faecal incontinence. Br J Surg. 2007; 94(6):749-53. DOI: 10.1002/bjs.5499. View

11.

Jarrett M, Matzel K, Stosser M, Christiansen J, Rosen H, Kamm M . Sacral nerve stimulation for faecal incontinence following a rectosigmoid resection for colorectal cancer. Int J Colorectal Dis. 2005; 20(5):446-51. DOI: 10.1007/s00384-004-0729-7. View

12.

Williams N, Johnston D . The quality of life after rectal excision for low rectal cancer. Br J Surg. 1983; 70(8):460-2. DOI: 10.1002/bjs.1800700805. View

13.

Ganio E, Ratto C, Masin A, Luc A, Doglietto G, Dodi G . Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience. Dis Colon Rectum. 2001; 44(7):965-70. DOI: 10.1007/BF02235484. View

14.

Fichera A, Michelassi F . Long-term prospective assessment of functional results after proctectomy with coloanal anastomosis. J Gastrointest Surg. 2001; 5(2):153-7. DOI: 10.1016/s1091-255x(01)80027-5. View

15.

Vassilakis J, Pechlivanides G, Zoras O, Vrachasotakis N, Chrysos E, Tzovaras G . Anorectal function after low anterior resection of the rectum. Int J Colorectal Dis. 1995; 10(2):101-6. DOI: 10.1007/BF00341207. View

16.

van Duijvendijk P, Slors F, Taat C, Heisterkamp S, Obertop H, Boeckxstaens G . A prospective evaluation of anorectal function after total mesorectal excision in patients with a rectal carcinoma. Surgery. 2003; 133(1):56-65. DOI: 10.1067/msy.2003.3. View

17.

Rockwood T, Church J, Fleshman J, Kane R, Mavrantonis C, Thorson A . Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000; 43(1):9-16; discussion 16-7. DOI: 10.1007/BF02237236. View

18.

Kakodkar R, Gupta S, Nundy S . Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome. Colorectal Dis. 2006; 8(8):650-6. DOI: 10.1111/j.1463-1318.2006.00992.x. View

19.

Matzel K, Stadelmaier U, Bittorf B, Hohenfellner M, Hohenberger W . Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int J Colorectal Dis. 2002; 17(6):430-4. DOI: 10.1007/s00384-002-0412-9. View