De Meyere C, Nuytens F, Parmentier I, D'Hondt M
Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium.
Tech Coloproctol. 2020 Sep;24(9):947-958. doi: 10.1007/s10151-020-02245-2. Epub 2020 Jun 16.
Sacral neuromodulation (SNM) has proven to be a safe and effective treatment for fecal incontinence (FI). For low anterior resection syndrome (LARS), however, SNM efficacy is still poorly documented. The primary aim of this study was to report on efficacy of SNM therapy for patients with isolated FI or LARS. Furthermore, we evaluated the safety of the procedure and the relevance of adequate follow-up.
A retrospective analysis was performed upon a prospectively maintained database of all patients who underwent SNM therapy for isolated FI or LARS between January 2014 and January 2019. The Wexner and LARS scores were evaluated at baseline, during test phase, after definitive implantation and annually during follow-up. Treatment success was defined as at least 50% improvement of the Wexner score or a reduction to minor or no LARS.
Out of 89 patients with isolated FI or LARS who had a SNM test phase, 62 patients were eligible for implantation of the permanent SNM device. At baseline, 3 weeks, and 1, 2, 3, 4 and 5 years after definitive implantation the median Wexner score of all patients was 18, 2, 4.5, 5, 5, 4 and 4.5, respectively, and 18, 4, 5.5, 5, 4, 3 and 4, respectively, for patients with FI and LARS. Patients with LARS more frequently required changes in program settings.
SNM therapy is a safe and effective treatment for patients with isolated FI and patients with FI and LARS. Adequate follow-up is essential to ensure long-term effectivity, especially for LARS patients.
骶神经调节（SNM）已被证明是治疗大便失禁（FI）的一种安全有效的方法。然而，对于低位前切除综合征（LARS），SNM的疗效仍缺乏充分记录。本研究的主要目的是报告SNM治疗孤立性FI或LARS患者的疗效。此外，我们评估了该手术的安全性以及充分随访的相关性。
对2014年1月至2019年1月期间因孤立性FI或LARS接受SNM治疗的所有患者的前瞻性维护数据库进行回顾性分析。在基线、测试阶段、最终植入后以及随访期间每年评估Wexner和LARS评分。治疗成功定义为Wexner评分至少提高50%或LARS减轻至轻度或无。
在89例接受SNM测试阶段的孤立性FI或LARS患者中，62例符合永久性SNM装置植入条件。在基线、最终植入后3周、1、2、3、4和5年时，所有患者的Wexner评分中位数分别为18、2、4.5、5、5、4和4.5，FI和LARS患者分别为18、4、5.5、5、4、3和4。LARS患者更频繁地需要调整程序设置。
SNM治疗对于孤立性FI患者以及合并FI和LARS的患者是一种安全有效的治疗方法。充分随访对于确保长期有效性至关重要，尤其是对于LARS患者。
