Functional outcome of sacral nerve stimulation in patients with severe constipation

Sacral nerve stimulation has been reported as an effective treatment for constipation.

This study aimed to evaluate the therapeutic efficacy of permanent sacral nerve stimulation on the treatment of idiopathic constipation resistant to medical and behavioral management over a median follow-up period of 25.6 (range, 6-96) months.

A retrospective review of a prospectively maintained institutional review board-approved database was performed.

The study was performed at 2 tertiary-care European institutions with expertise in sacral nerve stimulation.

Patients were considered eligible if they had had symptoms for at least 1 year and if conservative treatment had failed.

Patients were tested by percutaneous nerve evaluation before the procedure. If this evaluation was successful, patients underwent sacral nerve therapy with an implanted device.

Patients were evaluated by means of a bowel function diary and the Wexner constipation score.

A total of 48 consecutive patients (39 females, median age 50.0 years (range, 17-79 years) entered the study. Twenty-three patients were implanted with a permanent stimulator. On an intention-to-treat basis, only 14 of 48 patients (29.2%) met the definition of a successful outcome at the latest follow-up period (median, 25.6 (range, 6-96) months). The mean Wexner score decreased from 20.2 (SD 3.6) at baseline to 5.8 (SD 4.1) at the latest follow-up examination (p < 0.001). However, 6 of 14 patients (42.8%) were still using laxatives and/or enemas at the last follow-up.

The study was limited by the pragmatic approach necessary to evaluate the results in routine clinical practice.

This study shows that sacral nerve stimulation has limited efficacy on an intention-to-treat basis as a routinely recommended therapy for intractable idiopathic constipation.