Infection Rates in a Large Investigational Trial of Sacral Nerve Stimulation for Fecal Incontinence

Wexner, Steven D.; Hull, Tracy L.; Edden, Yair; Coller, John A.; Devroede, Ghislain; McCallum, Richard W.; Chan, Miranda K. Y.; Ayscue, Jennifer M.; Shobeiri, Abbas; Margolin, David A.; England, Michael; Kaufman, Howard S.; Snape, William J.; Mutlu, Ece; Chua, Heidi K; Pettit, Paul; Nagle, Deborah; Madoff, Robert D.; Lerew, Darin R.; Mellgren, Anders

doi:10.1007/s11605-010-1177-z

Cited by 95 publications

(47 citation statements)

References 20 publications

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“…This is a procedure that in the reviewed literature has a low complication or adverse effects rate, including surgical site infection. The incidence of infection in our series was 4%, a value similar to that described in other studies (range 1.6-10.8%) (13,14). In both cases infection occurred after definitive pacemaker implantation and prompted its withdrawal.…”

Section: Discussionsupporting

confidence: 89%

“…While no manipulation is needed in this second field, which is only for visually ascertaining motor responses, care should be taken not to contaminate instruments or surgeon hands, which may inadvertently touch this non-sterile area in their way to the puncture site. In the above-mentioned series (14), which discusses postoperative infection rates in 120 implanted patients, 5 of 13 cases with infection responded adequately to conservative therapy with antibiotics, whereas the rest had to have their stimulator explanted.…”

Section: Discussionmentioning

confidence: 99%

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Sacral nerve stimulation for fecal incontinence

Pascual

Ortega

et al. 2011

Rev. esp. enferm. dig.

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Objective: to analyze short-term outcomes and complications for our first fifty patients with fecal incontinence undergoing sacral root stimulation.Patients: fifty patients with fecal incontinence receiving sacral neuromodulation in 4 hospitals are reviewed. Discussed variables include: age, sex, incontinence duration, incontinence cause, prior surgery for incontinence, Wexner scale score, anorectal manometry parameters, and endoanal ultrasonographic findings. Following the procedure Wexner scale score, anorectal manometry parameters, and associated complications are reviewed.Results: mean age of patients is 59.9 years, with females predominating. Most common causes of incontinence include obstetric procedures, idiopathic origin, and prior anal surgery. Mean followup is 17.02 months. Follow-up revealed a statistically significant reduction in Wexner scale score and increase in voluntary anal pressure. Technique-derived minor complications included: 2 surgical wound infections that led to stimulator withdrawal; 2 patients with pain who were managed conservatively; 1 case of externalization in a gluteal stimulator; and 1 broken tetrapolar electrode.Conclusions: sacral nerve stimulation is a simple technique that improves Wexner scores in a statistically significant manner with a low complications rate.Key words: Fecal incontinence. Anal sphincter. Anorectal manometry. INTRODUCTIONSacral nerve stimulation in the management of fecal incontinence has led to a change in the diagnostic and therapeutic algorithm for this disease in recent years (1-5). This treatment modality so far removed from the common practice of general surgeons has forced coloproctology specialists to undergo specific education on the technique's theoretical and practical aspects in order to treat their patients.The procedure's absolute indication in fecal incontinence was initially focused on incontinent patients showing integrity of the sphincteric apparatus because of no previous lesions (idiopathic incontinence) or because of a prior sphincteroplaty procedure losing efficacy over time (incontinence most often resulting from obstetric trauma or prior surgery). Its indication has been gradually extended to patients with sphincteric defects (6-10), hence there is an ever increasing number of incontinent patients that are eligible for this procedure, also including stimulators indicated for constipation (11) and pain (12). As with all surgical skills, neuromodulation also displays a learning curve that may be shortened with workshops on stimulators and cadaveric training but cannot be obviated. The goal of this study was to analyze the first fifty cases by three general surgeon teams who used sacral root stimulations for the management of fecal incontinence, and to review the procedure's difficulties and short-term outcomes and complications. MATERIAL AND METHODSThe first fifty patients with fecal incontinence treated with sacral nerve stimulation in four Madrid sites from 2004 to 2009 are retrospectively reviewed. All patients are adults (older t...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Sacral nerve stimulation for fecal incontinence

Pascual

Ortega

et al. 2011

Rev. esp. enferm. dig.

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“…The CCF-FI median of the group at pre-operative assessment was 12 (9)(10)(11)(12)(13)(14) The CCF-FI median at pre-operative assessment was 14.1 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Resultsmentioning

confidence: 99%

Sacral nerve stimulation in the treatment of fecal incontinence – the experience of a pelvic floor center: Short-term results

Iachetta¹,

Cola²,

Villani³

2012

jig

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“…4 Infection usually presents as cellulitis over the site of the pulse generator, and requires removal of the stimulator and electrode. Pain can, however, be the sole presenting symptom of sacral nerve stimulator infection.…”

Section: Discussionmentioning

confidence: 99%

Presacral abscess as a rare complication of sacral nerve stimulator implantation

Gumber

Ayyar

Varia

et al. 2017

annals

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A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement.The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved.Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode. Sacral nerve stimulation is the implantation of a permanent pulse generator that delivers controlled electrical impulses via an electrode placed in contact with the sacral nerve roots, the S3 nerve root being the most common. It is of proven value in the treatment of urinary and faecal incontinence, urinary non-obstructive retention, and chronic pelvic and anal pain including proctalgia fugax. 1 We report the case of a 50-year-old man having severe anal pain attributed to proctalgia fugax for 7 years. Treatments with caudal epidural injection and ganglion impar block had been unsuccessful. He was referred to a tertiary centre for chronic pain management, where a temporary trial of S3 nerve stimulation was successful in controlling his anal pain. A permanent nerve stimulator was then implanted with the electrode being sited adjacent to the right S3 nerve root with good symptomatic relief. The patient presented 13 months later with symptoms and signs of sepsis including poor appetite, weight loss, night sweats, pyrexia, leucocytosis and elevated C-reactive protein. Computed tomography (CT) showed a chronic presacral abscess and magnetic resonance imaging (MRI) demonstrated enhancement along the pathway of the implanted electrode, indicating that the presacral abscess was caused by infectio...

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Infection Rates in a Large Investigational Trial of Sacral Nerve Stimulation for Fecal Incontinence

Cited by 95 publications

References 20 publications

Sacral nerve stimulation for fecal incontinence

Sacral nerve stimulation for fecal incontinence

Sacral nerve stimulation in the treatment of fecal incontinence – the experience of a pelvic floor center: Short-term results

Presacral abscess as a rare complication of sacral nerve stimulator implantation

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