Sacral nerve stimulation in faecal incontinence: position statement based on a collective experience

Leroi, Anne‐Marie; Damon, Henri; Faucheron, Jean‐Luc; Lehur, P.‐A.; Siproudhis, L.; Slim, K.; Barbieux, J.; Barth, X.; Borie, F.; Bresler, L.; Desfourneaux, Véronique; Goudet, P.; Huten, N.; Lebreton, Gil; Mathieu, Pierre; Meurette, G.; Mathonnet, Muriel; Mion, François; Orsoni, P; Parc, Yann; Portier, G.; Rullier, Éric; Sielezneff, I.; Zerbib, Frank; Michot, F; Nemo, Club

doi:10.1111/j.1463-1318.2009.01914.x

Cited by 67 publications

(43 citation statements)

References 56 publications

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“…Interestingly, the recently published multicenter position paper on SNS did not include any discussion of morbidity which highlights the relative safety of the procedure. 22 A third limitation was that this study did not assess either the economic or the financial burdens of explantation were assessed. A fourth study limitation is that based upon these results, no specific inclusion or exclusion criteria can be recommended.…”

Section: Discussionmentioning

confidence: 99%

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

Wexner

Hull

Edden

et al. 2010

Journal of Gastrointestinal Surgery

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Section: Discussionmentioning

confidence: 99%

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

Wexner

Hull

Edden

et al. 2010

Journal of Gastrointestinal Surgery

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“…The respondents' knowledge of the literature and manufacturer's guidelines was of particular interest. Up-to-date uniform recommendations from other European countries are available in Italy and France [35][36][37], and an exchange of knowledge in this highly standardized procedure may be of great value. Evidence-based classifications of treatment options for fecal incontinence exist [2,[38][39][40] and will be updated shortly.…”

Section: Discussionmentioning

confidence: 99%

Sacral nerve stimulation as a therapy for fecal incontinence

Kahlke

Fürst

Leder³

et al. 2016

coloproctology

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“…In total, nearly 40 % of patients needed a revision of their stimulator, but some of the reoperations were due to the learning curve, the patients in question having been the very first patients being included in the study. A position statement, based on a collective experience of French experts (the NEMO club), was published with the final goal of improving technical and functional results of sacral neuromodulation in fecal incontinence [10].…”

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confidence: 99%

Sacral neuromodulation for bowel dysfunction

Faucheron

Martín

2013

Tech Coloproctol

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Bowel dysfunction generally refers to a variety of clinical conditions including fecal incontinence, constipation, and chronic pelvic pain.Fecal incontinence is the uncontrolled loss of stool, either liquid or solid. Its true prevalence in the adult population is unknown, but might be as high as 5 % if based on a Cleveland Clinic score above 5/20 [1]. The resulting handicap is responsible for social isolation and reduced quality of life. First treatment should be dietary measures, medication, and biofeedback physiotherapy. Surgery is indicated when conservative treatment fails. Direct sphincter repair is suggested in the case of limited total sphincter rupture, but results deteriorate over time, with only around 50 % of patients still continent at long-term follow-up. Sphincter substitution is indicated in patients with large sphincter defects or a severely disrupted sphincter and in the case of failure of other surgical treatment. Non-stimulated graciloplasty (the so-called Pickrell's procedure) has been abandoned because of the fatigability of the transposed muscle [2]. Dynamic graciloplasty is nowadays very rarely proposed in the treatment of fecal incontinence because the technique is complex, expensive and has a high morbidity rate [3]. Despite a certain level of expertise, our results with the artificial bowel sphincter, like other authors have recently shown, are less promising than those previously published in the literature [4].Sacral nerve modulation, first developed for the treatment of urinary dysfunction, is another option that has proved to be effective in the treatment of fecal incontinence in patients with an intact or nearly intact sphincter complex [5]. Some authors have demonstrated that sacral neuromodulation could also be beneficial in patients with sphincter defects, in patients presenting with fecal incontinence following anterior resection and chemoradiation for rectal cancer, and in patients suffering from systemic sclerosis or Crohn's disease. After implantation, 41-75 % of patients achieve complete fecal continence and 75-100 % experience improvement in episodes of incontinence [5]. A few studies have also reported efficacy of sacral neuromodulation in patients suffering from double incontinence, the urinary incontinence being due to either urge incontinence (involuntary urine leakage following urgency), stress incontinence (involuntary urine leakage during efforts), or mixed (associating both urge and stress incontinence) [6,7].These functional results are obtained with a reasonable, moderate level of complications [8,9]. We published the number and causes of reoperation from a series of 87 consecutive patients operated on in a single institution. Among these patients, 36 had surgical revision of the device for the following reasons: device-related failure due to infection in 4 (successful reimplant in 4), electrode displacement in 2, electrode breakage in 2 (reimplantation of electrode in 4), and dysfunction owing to impedance increase in the system in 4; adverse stimulation with pa...

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Sacral nerve stimulation in faecal incontinence: position statement based on a collective experience

Abstract: We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.

Cited by 67 publications

References 56 publications

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

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

Sacral nerve stimulation as a therapy for fecal incontinence

Sacral neuromodulation for bowel dysfunction

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