Drissi F, Di Giuseppe M, Korkmaz C, Bourreille A, Tréton X, Ris F, Meurette G
Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 01, France.
Service de Chirurgie Digestive, Clinique Jules Verne, 2-4 route de Paris, 44314, Nantes Cedex 3, France.
Tech Coloproctol. 2025 May 3;29(1):105. doi: 10.1007/s10151-025-03140-4.
Postoperative frequency of bowel movements and impaired fecal continence (FI) has a negative impact on quality of life following ileal pouch-anal anastomosis. Sacral neuromodulation (SNM) is a validated treatment of FI, but its effectiveness in patients with ileal pouch-anal anastomosis (IPAA) has been poorly reported. The aim was to assess the results of SNM in patients with IPAA suffering from functional disorders and to compare these results with those of patients routinely treated by SNM for FI.
A 3-week test phase was performed before definitive implantation of the pulse generator. Patients' data were prospectively gathered in a dedicated registry. Patients with IPAA were then compared with a matched-paired control group of patients routinely treated by SNM for FI.
Between 2007 and 2020, 14 patients with IPAA were tested and 12 (85%) were implanted. This group was compared with a matched group of 20 patients implanted for FI. After a mean follow-up of 4.8 [0.5-16] years, there was a significant decrease of weekly leaks (29 versus 2; p = 0.01), decrease in Wexner score (15 versus 10.8; p = 0.01), and an improvement in quality of life (fecal incontinence quality of life (FIQOL) 1.853 versus 2.42; p = 0.01). Patients with IPAA evolved equally as compared with the control group in terms of Wexner score and quality of life at 6 months, 1 year, and 2 years.
SNM provides a significant decrease of leaks and improves Wexner scores and quality of life in patients with IPAA. The effectiveness seems comparable to patients routinely treated by SNM for FI. SNM indications could be extended to patients with IPAA who present with bad functional outcome.
回肠储袋肛管吻合术后排便频率及大便失禁（FI）对生活质量有负面影响。骶神经调节（SNM）是一种已得到验证的治疗FI的方法，但其在回肠储袋肛管吻合术（IPAA）患者中的有效性报道较少。本研究旨在评估SNM治疗IPAA功能障碍患者的效果，并将这些结果与接受SNM常规治疗的FI患者的结果进行比较。
在最终植入脉冲发生器之前进行为期3周的测试阶段。前瞻性收集患者数据并录入专用登记册。然后将IPAA患者与接受SNM常规治疗的FI配对对照组患者进行比较。
2007年至2020年期间，对14例IPAA患者进行了测试，其中12例（85%）植入了装置。将该组患者与20例因FI植入装置的配对组患者进行比较。平均随访4.8[0.5 - 16]年后，每周漏便次数显著减少（29次对2次；p = 0.01），Wexner评分降低（15分对10.8分；p = 0.01），生活质量得到改善（大便失禁生活质量量表（FIQOL）评分从1.853分提高到2.42分；p = 0.01）。在6个月、1年和2年时，IPAA患者在Wexner评分和生活质量方面与对照组患者的变化相当。
SNM可显著减少IPAA患者的漏便次数，改善Wexner评分和生活质量。其有效性似乎与接受SNM常规治疗的FI患者相当。SNM的适应证可扩展至功能结局不佳的IPAA患者。
