Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2017 02 09() doi 10.1111/codi.13624
Poor functional results, such as faecal incontinence (FI), low anterior resection syndrome (LARS) or high stool frequency can occur after colorectal resections; including proctocolectomy with ileal pouch-anal anastomosis (IPAA), rectal resection and left hemicolectomy. Management of these patients is an issue, and some case-reports have demonstrated the effectiveness of sacral nerve stimulation (SNS) in such situations. OUR AIM: was to analyse the effectiveness of SNS on poor functional results and on the quality of life, after different colorectal resections.
From 2006 to 2014, patients from 5 university hospitals suffering from poor functional results after rectal resection, IPAA or left hemicolectomy underwent a staged SNS implant procedure. Failure was defined by the absence or insufficient improvement (<50%) of FI episodes. RESULTS
Sixteen patients underwent SNS for bowel dysfunction after rectal resection with coloanal anastomosis, left hemicolectomy with colorectal anastomosis or IPAA. Two cases of primary failure were observed after the percutaneous stimulation test (13%). Median frequency of stool, FI episodes and urgency were significantly improved in 14 patients. Wexner’s and LARS scores were also significantly improved for 14 patients. When we compared results according to the type of colorectal surgery (IPAA, rectal resection or left hemicolectomy), median frequencies of stool and urgency, Wexner’s and LARS scores were still significantly improved. Overall success rate was 75% (12/16 patients) in intention-to-treat and 86% (12/14 patients with permanent electrode) in per-protocol analysis.
SNS seems to improve bowel dysfunction following rectal resection, left hemicolectomy or IPAA. This article is protected by copyright. All rights reserved.