Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment

Abstract

PurposeFunctional constipation in children and adolescents is a common and invalidating condition. In a minority of patients, symptoms persist despite optimal conservative therapy. The aim of this study was to evaluate whether the short-term effects of sacral neuromodulation (SNM) in children and adolescents with constipation are sustained over prolonged period of time.MethodsPatients aged 10–20 years, with refractory constipation, fulfilling the Rome III criteria, were included in our study. If SNM test treatment showed >50 % improvement in defecation frequency, a permanent stimulator was implanted. Primary outcome measure was defecation frequency during 3 weeks. Secondary endpoints were abdominal pain and Wexner score. To assess sustainability of treatment effect, a survival analysis was performed. Cross-sectional quality of life was assessed using the EQ-5D VAS score.ResultsThirty girls, mean age 16 (range 10–20), were included. The mean defecation frequency increased from 5.9 (SD 6.5) in 21 days at baseline to 17.4 (SD 11.6) after 3 weeks of test treatment (p < 0.001). During test treatment, abdominal pain and Wexner score decreased from 3.6 to 1.5 and 18.6 to 8.5 (p < 0.001), respectively. Improvement of symptoms sustained during a median follow-up of 22.1 months (12.2–36.8) in 42.9 % of patients. On a scale from 0 to 100, quality of life was 7 points lower than the norm score (mean 70 vs. 77).ConclusionSNM is a therapeutic option for children with chronic constipation not responding to intensive oral and/or laxative therapy, providing benefits that appear to be sustained over prolonged period of time.

Sacral nerve stimulation for constipation and fecal incontinence in children: Long‐term outcomes, patient benefit, and parent satisfaction

“…The authors concluded that although response to SNS was heterogeneous in their cohort, SNS does appear to provide sustained benefit for children with functional constipation refractory to conventional treatment. 11 Our findings add to the evidence that SNS can be an effective and durable treatment option for children with refractory constipation. Although our study included both patients with organic causes of constipation and functional constipation, subgroup analysis of patients with functional constipation demonstrated clinical improvement and patient benefit that was similar to that of our entire cohort.…”

“…7,8 Experience with the use of SNS in children with constipation has been positive thus far but remains limited, and the long-term outcomes of SNS treatment in children with constipation are not yet clearly understood. [9][10][11] Although SNS appears to be a promising treatment option for children with refractory constipation, an understanding of its long-term efficacy and safety in children is needed before this treatment modality becomes more widely accepted. Therefore, the objective of our study was to describe the long-term outcomes of children with constipation treated with SNS by evaluating changes in symptom severity and quality of life, perceived health-related patient benefit, and parent satisfaction.…”

Cost‐effectiveness of sacral neuromodulation for chronic refractory constipation in children and adolescents: a Markov model analysis

“…Model input was based on data collected from a cohort of 30 consecutive female patients who were referred to our centre for evaluation and possible SNM. Data regarding defaecation frequency were prospectively collected, with a median follow-up of 22.1 months [11]. All patients had functional constipation and met ROME-3 criteria for CRC (fewer than three evacuations per week for at least the previous 6 months, combined with frequent straining, lumpy or hard stools and/or sensation of incomplete evacuation) [12].…”

Surgical management of children with intractable functional constipation; experience of a single tertiary children's hospital

“…Since there are no guidelines for surgery in children with intractable FC, the choice of surgical intervention is challenging and the approach differs among centers . Surgical options include botulinum toxin injections into the anal sphincter complex, anal sphincter myectomy, sacral nerve stimulation (SNS), creation of an access for administration of antegrade enemas, segmental or total colonic resection, and temporary/permanent diverting ileostomy, and colostomy . The rationale for diversion via an ostomy is to relieve symptoms and to decompress the colon, giving the diverted colonic segment time to recover.…”

“…13 Surgical options include botulinum toxin injections into the anal sphincter complex, anal sphincter myectomy, sacral nerve stimulation (SNS), creation of an access for administration of antegrade enemas, segmental or total colonic resection, and temporary/ permanent diverting ileostomy, and colostomy. 11,14 The rationale for diversion via an ostomy is to relieve symptoms and to decompress the colon, giving the diverted colonic segment time to recover. Several studies have shown that diversion of a dysmotile colonic segment can lead to improvement of colonic motility in that segment.…”