Ten-year Evaluation of a Large Retrospective Cohort Treated by Sacral Nerve Modulation for Fecal Incontinence

Desprez, Charlotte; Damon, Henri; Meurette, G.; Mège, Diane; Faucheron, Jean‐Luc; Brochard, Charlène; Lambrescak, Elsa; Gourcerol, Guillaume; Mion, François; Wyart, Vincent; Sielezneff, I.; Siproudhis, L.; Etienney, Isabelle; Ajamie, Nadine; Lehur, Paul‐Antoine; Duflot, Thomas; Bridoux, Valérie; Leroi, Anne‐Marie; Nemo, Club

doi:10.1097/sla.0000000000004251

Cited by 15 publications

(10 citation statements)

References 35 publications

(88 reference statements)

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“…Given the difficulties in obtaining FI severity and quality scores and/or bowel diaries over a long follow‐up period, the outcome of SNM was defined as favourable if the patient reported a therapeutic benefit from SNM and did not consider discontinuation or additional therapy beyond the use of medications to modify bowel transit. Treatment outcome was defined as unfavourable if the patient was not satisfied with SNM and required an alternative treatment (medical treatment excluded) such as stoma formation or trans‐anal irrigation or if the patient had switched off the IPG or had had it surgically removed [14].…”

Section: Methodsmentioning

confidence: 99%

“…Data are expressed as means ± standard deviation (SD) or as median (interquartile range) if nonnormally distributed. The proportion of patients in each outcome was determined for both the intention to treat (ITT) approach and the per protocol (PP) approach [14]. For quantitative endpoints, Student’s t ‐test or the Mann–Whitney test, as appropriate, was used to compare groups.…”

Section: Methodsmentioning

confidence: 99%

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Is sacral nerve modulation reprogramming effective after permanent implantation for faecal incontinence?

Desprez¹,

Grange²,

Gourcerol

et al. 2022

Colorectal Disease

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Aim Sacral nerve modulation (SNM) is recommended as a first‐line surgical therapy for patients with faecal incontinence (FI). During patient follow‐up, it is recommended that stimulation settings be reprogrammed to optimize patient outcomes. The aim of the present study was to evaluate the efficacy of stimulator reprogramming in patients with an implanted SNM device to treat FI. Method The data from patients who received a permanent SNM implant in a single centre from January 2008 to December 2019 were retrospectively analysed. Symptoms that occurred after implantation, the stimulator settings of the SNM device and changes made at each follow‐up visit were noted. The efficacy of reprogramming was determined by assessing patient satisfaction. Results Of the 117 patients (male/female 4/113; mean age 59.5 ± 11.8 years) with a SNM implant for FI, 84 (72%) had at least one symptom requiring reprogramming of the stimulator, most often during the first year after implantation (p = 0.05). The most frequently reported symptoms were loss of efficacy (68.5%; p = 1 × 10−3) and pain (20.5%; p = 1 × 10−3). Reprogramming was effective 53% of the time when treating loss of efficacy and 76% of the time when treating pain. When the stimulation parameters were reprogrammed at least four consecutive times to correct a symptom, the reprogramming was less effective in treating the symptom (p = 0.02). Conclusion Regular follow‐up of patients with SNM device implants associated with reprogramming of stimulation parameters to improve the treatment of reported symptoms would optimize the efficacy of SNM.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Is sacral nerve modulation reprogramming effective after permanent implantation for faecal incontinence?

Desprez¹,

Grange²,

Gourcerol

et al. 2022

Colorectal Disease

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“…These are activated by sacral nerve stimulation, an increasingly used, front-line treatment for faecal incontinence. 35 Intestinofugal neurons are a peculiar class of enteric neurons with cell bodies in the myenteric ganglia with their axons projecting out of the gut to synapse with sympathetic neurons in prevertebral ganglia. In several laboratory animals these pathways mediate intestino-intestinal inhibitory reflexes.…”

Section: Cellular Morphology Of Enteric Neuronesmentioning

confidence: 99%

“…From here, their effects are mediated by postganglionic nerve fibres to the pelvic organs. These are activated by sacral nerve stimulation, an increasingly used, front‐line treatment for faecal incontinence 35 …”

Section: Structure Of the Enteric Nervous Systemmentioning

confidence: 99%

The human enteric nervous system. Historical and modern advances. Collaboration between science and surgery

Wattchow

Hibberd

Spencer

et al. 2022

ANZ Journal of Surgery

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Background: There are considerable advantages and opportunities for surgeons and trainee surgeons in conducting a period of research allied with basic scientists. Such clinicians are well placed to define relevant clinical questions, provide human material (tissue, biopsy and blood) and translate the techniques derived in experimental animals to human subjects. Methods: This small review explores research conducted on the nervous system of the intestines, with an emphasis on the translation of findings from animal to human. Results: This work shows that new techniques of immunohistochemistry and retrograde tracing, developed in animal tissue, have greatly expanded our knowledge of the structure of the human enteric nervous system. Conclusions: Such findings have sparked therapeutic trials for the treatment of gastrointestinal disorders in patients.

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“…The treatment is effective in the long-term [intention-to-treat 54% over a median of 56 months follow up ( Thin et al, 2013 )], with complete continence achieved in about one third of patients ( Altomare et al, 2015 ). A recent retrospective study showed that efficacy is maintained in 45% of patients at 10 years post-implantation ( Desprez et al, 2020 ). Whilst some evidence has been provided by small double-blind crossover studies, randomized data are lacking, and experimental efficacy has not yet been validated in an adequately powered clinical trial ( Thaha et al, 2015 ; McAlees et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological Responses in the Human S3 Nerve During Sacral Neuromodulation for Fecal Incontinence

et al. 2021

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Intra-operative electrode placement for sacral neuromodulation (SNM) relies on visual observation of motor contractions alone, lacking complete information on neural activation from stimulation. This study aimed to determine whether electrophysiological responses can be recorded directly from the S3 sacral nerve during therapeutic SNM in patients with fecal incontinence, and to characterize such responses in order to better understand the mechanism of action (MOA) and whether stimulation is subject to changes in posture. Eleven patients undergoing SNM were prospectively recruited. A bespoke stimulating and recording system was connected (both intraoperatively and postoperatively) to externalized SNM leads, and electrophysiological responses to monopolar current sweeps on each electrode were recorded and analyzed. The nature and thresholds of muscle contractions (intraoperatively) and patient-reported stimulation perception were recorded. We identified both neural responses (evoked compound action potentials) as well as myoelectric responses (far-field potentials from muscle activation). We identified large myelinated fibers (conduction velocity: 36–60 m/s) in 5/11 patients, correlating with patient-reported stimulation perception, and smaller myelinated fibers (conduction velocity <15 m/s) in 4/11 patients (not associated with any sensation). Myoelectric responses (observed in 7/11 patients) were attributed to pelvic floor and/or anal sphincter contraction. Responses varied with changes in posture. We present the first direct electrophysiological responses recorded from the S3 nerve during ongoing SNM in humans, showing both neural and myoelectric responses. These recordings highlight heterogeneity of neural and myoelectric responses (relevant to understanding MOA of SNM) and confirm that electrode lead position can change with posture.

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Ten-year Evaluation of a Large Retrospective Cohort Treated by Sacral Nerve Modulation for Fecal Incontinence

Cited by 15 publications

References 35 publications

Is sacral nerve modulation reprogramming effective after permanent implantation for faecal incontinence?

Is sacral nerve modulation reprogramming effective after permanent implantation for faecal incontinence?

The human enteric nervous system. Historical and modern advances. Collaboration between science and surgery

Electrophysiological Responses in the Human S3 Nerve During Sacral Neuromodulation for Fecal Incontinence

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