Pediatr Surg. 2023 Apr 20;S0022-3468(23)00249-X. doi: 10.1016/j.jpedsurg.2023.04.007.Online ahead of print.

Stephen Trinidad ¹, Amanda Jensen ², Monica Holder ¹, Allison Elsner ¹, Nelson Rosen ³, Aaron Garrison ³, Beth Rymeski ³, Jason S Frischer ⁴

Author information

¹Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

²Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN, USA; The Indiana University School of Medicine, Indianapolis, IN, USA.

³Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

⁴Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: Jason.Frischer@cchmc.org.

Abstract

Introduction: The goal of this study was to evaluate outcomes in patients treated with sacral nerve stimulation (SNS) for medically refractory fecal incontinence or severe constipation.

Methods: We performed a retrospective cohort study of all patients treated with SNS after failed medical management at a single center between 9/1/2015 and 6/30/2022. Demographic and clinical data was extracted from the electronic medical record. Rates of involuntary bowel movements were evaluated using a bowel severity score questionnaire and compared pre- and post-SNS using McNemar and McNemar-Bowker tests.

Results: 70 patients underwent SNS placement. The median age was 12.8 years (IQR 8.6-16.0) and 61.4% were male. The most common diagnosis was idiopathic constipation (67.1%), followed by anorectal malformation (15.7%), and others. 43 patients had severity scores recorded both pre- and at least 90 days post-SNS insertion. The rates of daytime and nighttime involuntary bowel movements were significantly different pre-compared to post-SNS placement (p = 0.038 and p = 0.049, respectively). The rate of daytime and nighttime fecal continence increased from 44% to 58.1% and 53.5%-83.7%, respectively. The rate of at least weekly daytime and nighttime fecal incontinence decreased from 48.8% to 18.7% and 34.9%-7.0%, respectively. Minor pain/neurological symptoms occurred in 40% of patients, while 5.7% developed a wound infection. Further surgery for the SNS was required in 40% of patients.

Conclusions: SNS placement can be an effective treatment for medically refractory fecal incontinence. Minor complications and the need for further procedures are common, while more serious complications like wound infections are rare.

Type of study: Retrospective Cohort Study.

Level of evidence: Level 3.