Sacral Neuromodulation Therapy

Wunnik, Bart P. van; Peeters, Babette; Govaert, B.; Nieman, Fred; Benninga, Marc A.; Baeten, C. G. M. I.

doi:10.1097/dcr.0b013e3182405c61

Cited by 73 publications

(11 citation statements)

References 31 publications

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“…SNS was a validated treatment option for urinary voiding dysfunction (31) and fecal incontinence in humans (52). Although a large number of studies have been published to investigate the therapeutic potential of SNS for constipation, most of those studies were flawed in methodologies and/or designs, such as being uncontrolled (21,25,26,34,46), retrospective (39,56), or very much underpowered (29). Although a few studies suggested a therapeutic effect of SNS on constipation, two recent randomized, controlled studies by Dinning et 61) indicated that SNS did not improve symptoms in patients with constipation.…”

Section: Discussionmentioning

confidence: 99%

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Sacral nerve stimulation with appropriate parameters improves constipation in rats by enhancing colon motility mediated via the autonomic-cholinergic mechanisms

Huang

Li²,

Foreman

et al. 2019

American Journal of Physiology-Gastrointestinal and Liver Physi

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Although sacral nerve stimulation (SNS) has been applied for treating constipation, its parameters were adopted from SNS for fecal incontinence, its effects are limited, and mechanisms are largely unknown. We investigated the effects and mechanism of SNS with appropriate parameters on constipation in rats treated with loperamide. First, using rectal compliance as an outcome measure, an experiment was performed to derive effective SNS parameters. Then, a 7-day SNS was performed in rats with constipation induced by loperamide. Autonomic functions were assessed by spectral analysis of heart rate variability (HRV) derived from an electrocardiogram. Serum levels of pancreatic polypeptide (PP), norepinephrine (NE), and acetylcholine (ACh) in colon were assessed. 1) Acute SNS at 5 Hz, 100 µs was found effective in enhancing rectal compliance and accelerating distal colon transit ( P < 0.05 vs. sham SNS). 2) The 7-day SNS normalized loperamide-induced constipation, assessed by the number, weight, and water content of fecal pellets, and accelerated the distal colon transit (29.4 ± 3.7 min with sham SNS vs. 16.4 ± 5.3 min with SNS but not gastric emptying or intestinal transit. 3) SNS significantly increased vagal activity ( P = 0.035) and decreased sympathetic activity ( P = 0.012), assessed by spectral analysis of HRV as well as by the serum PP. 4) SNS increased ACh in the colon tissue; atropine blocked the accelerative effect of SNS on distal colon transit. We concluded that SNS with appropriate parameters improves constipation induced by loperamide by accelerating distal colon motility, mediated via the autonomic-cholinergic function. NEW & NOTEWORTHY Although sacral nerve stimulation (SNS) has been applied for treating constipation, its parameters were adopted from SNS for fecal incontinence, effects are limited, and mechanisms are largely unknown. This paper shows that SNS with appropriate parameters improves constipation induced by loperamide by accelerating distal colon motility mediated via the autonomic-cholinergic function.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated that SNS shows promise in treating idiopathic constipation (25,39,46,56). However, a number of recent studies have failed to establish the efficacy of SNS for constipation (15,21,34,42,61).…”

Section: Introductionmentioning

confidence: 99%

Sacral nerve stimulation with appropriate parameters improves constipation in rats by enhancing colon motility mediated via the autonomic-cholinergic mechanisms

Huang

Li²,

Foreman

et al. 2019

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…For fecal incontinence, SNM appeared to be cost-effective [ 10 , 23 ]. For constipation, these analyses have not been performed yet.…”

Section: Discussionmentioning

confidence: 99%

“…In adults, studies of SNM for functional bowel complaints showed a positive effect on idiopathic slow and normal transit constipation resistant to conservative treatment [ 9 ]. Our preliminary data suggest that SNM may also be beneficial in young patients aged 10–20 years with refractory constipation [ 10 ]. It is unknown, however, whether relief of symptoms is sustained.…”

Section: Introductionmentioning

confidence: 99%

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

Wilt

Wunnik

Sturkenboom

et al. 2016

Int J Colorectal Dis

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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.

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“… 18 In addition, sacral neuromodulation therapy has been successfully applied in adolescents with refractory functional constipation. 19 Although satisfactory outcomes regarding function have been reported in the long-term follow-up of these studies, the incidence of complications is still unknown. The use of subtotal colectomy combined with the modified Duhamel procedure, named the Jinling procedure, has been reported for the treatment of adult Hirschsprung disease, and this procedure is effective in improving the constipation scale, bowel function score, and GQL index.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-Assisted Subtotal Colectomy Combined With Modified Duhamel Procedure for Mixed Constipation

Zhu

et al. 2015

JSLS

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Background and Objectives:To evaluate the effects of subtotal colectomy combined with the modified Duhamel procedure on mixed constipation.Methods:A total of 16 female patients with mixed constipation were enrolled and underwent subtotal colectomy combined with the modified Duhamel procedure under laparoscopy from April 2010 to April 2012. Before surgery, physical examinations such as the gastrointestinal transit test, barium enema, and defecography were performed for all the patients. After surgical treatment, 2-year follow-up was performed using questionnaires to assess the effect of treatment.Results:All 16 cases were treated successfully, with a mean operation time of 230 minutes (range, 180–290 minutes). No intraoperative or postoperative complications were found, and no deaths occurred. Constipation and relevant symptoms were relieved, and all patients were satisfied with their quality of life. The gastrointestinal quality-of-life score was significantly increased 6 months postoperatively (mean, 102) compared with preoperatively (mean, 75).Conclusion:Subtotal colectomy combined with the modified Duhamel procedure under laparoscopy is effective and safe for the treatment of mixed constipation.

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Sacral Neuromodulation Therapy

Abstract: Sacral neuromodulation appears to be a promising new treatment option in adolescents with refractory functional constipation not responding to intensive conservative therapy. Larger randomized studies with long-term follow-up are required.

Cited by 73 publications

References 31 publications

Sacral nerve stimulation with appropriate parameters improves constipation in rats by enhancing colon motility mediated via the autonomic-cholinergic mechanisms

Sacral nerve stimulation with appropriate parameters improves constipation in rats by enhancing colon motility mediated via the autonomic-cholinergic mechanisms

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

Laparoscopic-Assisted Subtotal Colectomy Combined With Modified Duhamel Procedure for Mixed Constipation

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