L Oliveira1,2, G Hagerman3, M L Torres4, C M Lumi5, J A C Siachoque6, J C Reyes7, J Perez-Aguirre8, J C Sanchez-Robles9, V H Guerrero-Guerrero9, S M Regadas10, V G Filho11, G Rosato12, E Vieira13, L Marzan14, D Lima15, E Londoño-Schimmer16, S D Wexner17. 1. Department of Anorectal Physiology of Rio de Janeiro, CEPEMED, Rua Visc.de Pirajá 414/812, Ipanema, Rio de Janeiro, 22410-002, Brazil. draluciaol@gmail.com. 2. Colorectal Surgery, Casa de Saúde São José, Rua Macedo Sobrinho, 21 - Humaitá, Rio de Janeiro, RJ, Brazil. draluciaol@gmail.com. 3. Colorectal Surgery, Centro Medico ABC Universidad Panamericana, Alvaro Obregon, Mexico City, Mexico. 4. Colorectal Clinic of Puerto Rico, San Juan, PR, USA. 5. Department of Surgery, Hospital de Gastroenterologia, Buenos Aires, Argentina. 6. Department of Surgery, Fundacion Santa Fe de Bogota, Bogotá, Colombia. 7. Coloproctology Unit, Department of Surgery, Clinical del Country, Bogotá, Colombia. 8. Hospital Militar de Ciudad de Mexico, Mexico City, Mexico. 9. Hospital Central Militar Universidad del Ejercito y Fuerza, Cuauhtémoc, Mexico. 10. Universidade Federal do Ceará, Fortaleza, Brazil. 11. Hospital Santa Rita de Maringa, Maringá, Parana, Brazil. 12. Colorectal Surgery, Hospital Universitario Austral, Buenos Aires, Argentina. 13. Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 14. Hospital Federal da Lagoa, Rio de Janeiro, Brazil. 15. Anorectal Physiology Department, Gastroclínica Cascavel, Cascavel, Parana, Brazil. 16. Universidad de los Andes, Bogotá, Colombia. 17. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Abstract
BACKGROUND: Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America. METHODS: A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1-84) months. RESULTS: One hundred and thirty-one patients [119 females, median age of 62.2 (range 19-87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1-84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as "significant". CONCLUSIONS: Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.
BACKGROUND: Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America. METHODS: A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1-84) months. RESULTS: One hundred and thirty-one patients [119 females, median age of 62.2 (range 19-87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1-84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as "significant". CONCLUSIONS: Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.
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