Sacral Nerve Stimulation in Patients After Rectal Resection—Preliminary Report

Holzer, Brigitte; Rosén, Harald; Zaglmaier, Wolfgang; Klug, R.; Beer, Bernhard; Novi, Gabriele; Schiessel, R

doi:10.1007/s11605-008-0485-z

Cited by 61 publications

(62 citation statements)

References 19 publications

(26 reference statements)

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“…Sacral nerve stimulation (SNS) has been advocated as a safe and effective therapy for severe FI and shown to be associated with minimal morbidity [2]. In patients with FI after anterior resection (AR), SNS is has been used in few cases, with varying results [1,3].Between 2006 and 2009, four patients (one male, three female), with severe FI following neoadjuvant therapy and AR performed for rectal cancer, were treated in our hospital with SNS. The median age was 65.5 years (range 49-73 years).…”

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Sacral nerve stimulation in patients with severe fecal incontinence after rectal resection

et al. 2012

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Oncologic resection of rectal cancer has been reported to be associated with a significant rate of fecal incontinence (FI). The risk is greater in patients with a resection less than 6-8 cm from the anal verge [1]. Sacral nerve stimulation (SNS) has been advocated as a safe and effective therapy for severe FI and shown to be associated with minimal morbidity [2]. In patients with FI after anterior resection (AR), SNS is has been used in few cases, with varying results [1,3].Between 2006 and 2009, four patients (one male, three female), with severe FI following neoadjuvant therapy and AR performed for rectal cancer, were treated in our hospital with SNS. The median age was 65.5 years (range 49-73 years). All patients had undergone chemoradiation before the operation. Total mesorectal excision and longitudinal coloplasty had been performed during the operation in all patients. The mean distance of the anastomosis from the anorectal ring was 5 cm (range 2-8 cm). The median history of FI following AR was 26.5 months (range 25-28 months). None presented tumor recurrence, local or distant. The incontinence status was classified according to the Wexner score [4].All patients were treated with conservative treatment, including drugs, constipating diet and biofeedback physiotherapy for 2 years. Before surgery, in all patients, anorectal manometry and endoanal ultrasonography were performed (Table 1). The percutaneous test stimulation was performed under general anesthesia. The response of S2-S4 was tested on both sides. If contraction of the anal sphincters could be obtained by SNS, percutaneous electrodes (Medtronic Ò 3050; Medtronic, Minneapolis, MN, USA) were implanted. The patients were subsequently tested by SNS for a 4-week period. Patients who became candidates for permanent implantation based on an improvement of their continence received the permanent stimulation generator (INTERSTIM II, 3058; Medtronic, Minneapolis, MN, USA) under general anesthesia. Differences were analyzed by the Wilcoxon test for paired data.All patients tested had contraction of the anal sphincters during the SNS 4-week test period. All patients had least a 50 % reduction in episodes of incontinence and were given a permanently implanted system. The Wexner score fell from a median score of 15.5 before SNS to 5.5 during permanent stimulation (p \ 0.005). There were no significant differences in sphincter pressures measured by anal manometry. The patients with associated urinary incontinence presented improvement in their symptoms. There was no cessation of clinical response during the follow-up, and no complications were observed.After colorectal or coloanal anastomoses at a lower location, about 30-60 % of patients develop anal dysfunction due to the loss of the rectum and internal sphincter. These patients develop clinical symptoms and signs, such as anterior resection syndrome, which includes stool frequency, urgency, fragmentation and soiling. These symptoms usually disappear approximately 1 year postoperatively [5]. Our results of SNS i...

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Sacral nerve stimulation in patients with severe fecal incontinence after rectal resection

et al. 2012

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“…Sacral neuromodulation has been advocated as a safe and effective therapy for severe fecal incontinence and shown to be associated with minimal morbidity [51,52]. In the literature, the experience with sacral neuromodulation in patients with fecal incontinence related to the anterior resection syndrome is still limited [53][54][55][56][57]. However, this minimally invasive therapeutic option been considered as the first choice in surgical treatment when conservative therapies fail [54][55][56].…”

Section: Treatment Of Fecal Incontinencementioning

confidence: 99%

Effects of Radiation Therapy for Rectal Cancer on Anorectal Function

Jorge

Habr‐Gama

Bustamante-Lopez

2015

Radiation Therapy for Pelvic Malignancy and Its Consequences

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“…The efficacy of sacral neuromodulation in partial sphincter injury has also been demonstrated (35)(36)(37). In patients with scleroderma having proctitis caused by radiation and reduced rectal compliance owing to inflammatory bowel syndrome and in patients with anterior resection or previous rectal prolapse colectomy, the efficacy of sacral neuromodulation is demonstrated only in few studies (38)(39)(40)(41)(42)(43).…”

Section: Gastrointestinal Disordersmentioning

confidence: 99%

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

Ozyalcin¹

2015

Turk J Phys Med Rehab

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The aim of this article is to determine the effectiveness and the safety of sacral nerve stimulation on the several indications. Sacral nerve stimulation as a neuromodulation technique, is an effective and increasingly used therapeutic option. As a minimally invasive technique, many advances in the techniques for sacral neuromodulation have been described. The well-known indication of sacral nerve stimulation is the urinary voiding dysfunction. Although the mechanism of neuromodulation is still unclear, multipl new indications have been identified, include faecal incontinence, constipation, pain sydromes, interstitial cystitis, mixt urinary and bowel disoders, spinal injury and neurodegenerative disease, and sexual dysfunction. Since there is lack of high quality evidence of the procedure at present, good quality prospective, cross-over and randomize controlled studies are required to determine the true benefits of sacral nerve stimulation.

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Sacral Nerve Stimulation in Patients After Rectal Resection—Preliminary Report

Cited by 61 publications

References 19 publications

Sacral nerve stimulation in patients with severe fecal incontinence after rectal resection

Sacral nerve stimulation in patients with severe fecal incontinence after rectal resection

Effects of Radiation Therapy for Rectal Cancer on Anorectal Function

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

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