Sacral Nerve Modulation in the Treatment of Fecal Incontinence Following Repair of Rectal Prolapse

Abstract

PURPOSE: Persistent or newly-diagnosed fecal incontinence following surgical repair of rectal prolapse has been reported in up to 30% of all treated patients. This study tried to evaluate the role of sacral nerve modulation as a potential treatment for this problem. PATIENTS AND METHODS: The medical records of 11 patients (all female; median age, 59 years) in 2 coloproctology centers were retrospectively analyzed. All of the patients had been treated for fecal incontinence by sacral nerve modulation, following transabdominal or transanal repair of rectal prolapse. After a median history of 36 (11-72) months following surgery, patients complained about fecal incontinence (median Cleveland Clinic Incontinence Score, 15 (13-20)), and sacral nerve modulation was proposed. The effect of sacral nerve modulation on the Cleveland score, as well as on the quality of life scoring system of The American Society of Colon and Rectal Surgeons, was evaluated. RESULTS: Based on their continence diaries, 9 of 11 patients reported an improvement of their fecal incontinence during the screening period, and proceeded to a permanent implant. After a median follow-up time of 36 (12-72) months, fecal incontinence scores dropped from a median of 15 (13-20) preoperatively to a median of 5 (3-7) in all implanted patients (P < .01). Quality of life analysis for all implanted patients showed significant improvement in all 4 domains (lifestyle, coping behavior, depression, and embarrassment (P < .01)). CONCLUSION: In this series, with a limited number of patients, sacral nerve modulation has shown a positive effect on the treatment of both persistent and newly-reported fecal incontinence after surgical repair of rectal prolapse.