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Abstract

Background:

Anal sphincter surgery for faecal incontinence is associated with significant morbidity and a variable outcome. Sacral nerve stimulation may provide a good functional outcome with minimal morbidity. This paper reports the experience in a single centre over 5 years.

Methods:

Fifteen consecutive patients (14 women), median age 60 (range 37–71) years, underwent temporary, and subsequent permanent, stimulation. All had incontinence to solid or liquid stool; the aetiology was obstetric injury (seven patients), scleroderma (four), idiopathic (two), fistula surgery (one) and repaired rectal prolapse (one). Median duration of symptoms was 6 (range 2–15) years. Clinical evaluation, endoanal ultrasonography, bowel diary, quality of life questionnaire (Short Form (SF) 36) and anorectal physiological testing were performed before and after stimulation.

Results:

Continence had improved in all patients at median follow-up of 24 (range 3–60) months. Eleven patients were fully continent. Episodes of faecal incontinence decreased from median (range) 11 (2–30) per week before stimulation to 0 (0–4) per week after permanent stimulation (P < 0·001). Urgency improved in all patients (median (range) ability to defer less than 1 (0–1) versus 8 (1–15) min; P = 0·01). ‘Social function’ and ‘role-physical’ subscales of the SF36 improved significantly. Mean resting pressure (35 versus 49 cmH2O with temporary stimulation; P < 0·05) and squeeze pressure increment (43 versus 69 cmH2O with permanent stimulation; P < 0·01) increased. Rectal sensitivity to initial distension changed (mean 47 versus 34 ml air; P < 0·05). There were no major complications.

Conclusion:

Sacral nerve stimulation is a safe and effective treatment for faecal incontinence when conventional treatment has failed. There is minimal morbidity. The benefit is maintained in the medium term. © 2002 British Journal of Surgery Society Ltd