Abstract
PurposeFunctional results after proctocolectomy and ileal pouch-anal anastomosis (IPAA) are generally good. However, some patients suffer from high stool frequency or fecal incontinence. Sacral nerve stimulation (SNS) may represent a therapeutic alternative in these patients, but little is known about indication and results. The aim of this study was to evaluate incontinence after IPAA and demonstrate SNS feasibility in these patients.MethodsThis retrospective study includes patients who received a SNS between 1993 and 2020 for increased stool frequency or fecal incontinence after proctocolectomy with IPAA for ulcerative colitis. Proctocolectomy was performed in a two- or three-step approach with ileostomy closure as the last step. Demographic, follow-up data and functional results were obtained from the hospital database.ResultsSNS was performed in 23 patients. Median follow-up time after SNS was 6.5 years (min. 4.2–max. 8.8). Two patients were lost to follow-up. The median time from ileostomy closure to SNS implantation was 6 years (min. 0.5–max. 14.5). Continence after SNS improved in 16 patients (69%) with a median St. Marks score for anal incontinence of 19 (min. 4–max. 22) before SNS compared to 4 (0–10) after SNS placement (p = 0.012). In seven patients, SNS therapy was not successful.ConclusionSNS implantation improves symptoms in over two-thirds of patients suffering from high stool frequency or fecal incontinence after proctocolectomy with IPAA. Awareness of the beneficial effects of SNS should be increased in physicians involved in the management of these patients.
Highlights
J-pouch formation with ileal pouch-anal anastomosis (IPAA) is the restorative procedure of choice after proctocolectomy [1]
We aimed to evaluate the effectiveness and usefulness of Sacral nerve stimulation (SNS) therapy for the treatment of fecal incontinence according to IPAA
This is a retrospective single-center, single-cohort outcome study evaluating the effect of SNS in patients with high stool frequency or fecal incontinence after proctocolectomy with J-pouch reconstruction and IPAA
Summary
J-pouch formation with ileal pouch-anal anastomosis (IPAA) is the restorative procedure of choice after proctocolectomy [1]. Fecal incontinence may be a consequence and negatively impact quality of life (QoL) and overall outcome. Fecal incontinence is defined as the inability to control feces or gas. The range of fecal incontinence described after IPAA varies widely and seems to progress over time [3,4,5]. Daytime stool incontinence is described in 1 to 25% of patients after J-pouch formation with IPAA [2,3,4,5,6,7]. Incontinence at night seems to be more common at 8 to 49% [3,4,5,6,7,8]. Increased stool frequency is another reported factor that negatively impacts quality of life [9]
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