Estimulación del nervio sacro para la incontinencia fecal en lesiones espinales

«Estimulación del nervio sacro para la incontinencia fecal en pacientes con lesión espinal parcial previa inclusive prolapso de disco.

M. E. D. Jarrett 1, K. E. Matzel 2, J. Christiansen 3, C. G. M. I. Baeten 4, H. Rosen 5, B. Bittorf 2, M. Stösser 6, R. Madoff 7, M. A. Kamm 1 *

1Department of Physiology, St. Mark’s Hospital, London, UK 2Department of General Surgery, University Hospital Erlangen, Erlangen, Germany 3Department of Surgery, Herlev Hospital, Herlev, Denmark 4Department of General Surgery, Maastricht University Hospital, Maastricht, The Netherlands 5Department of General Surgery, Danube Hospital, Vienna, Austria 6Medtronic Europe Sarl, Tolochenaz, Switzerland 7Department of Surgery, University of Minnesota, Minneapolis, USA

Abstract

Background: This study examined the use of sacral nerve stimulation (SNS) to treat faecal incontinence in patients with partial spinal injury.

Methods: Patients selected for SNS had experienced more than one episode of faecal incontinence per week to liquid or solid stool for more than 1 year and had failed maximal conservative treatment. All patients had an intact external anal sphincter.

Results: Temporary SNS was performed in 13 patients (median age 58·5 (range 39-73) years). The spinal insults were disc prolapse (six), trauma (four), spinal stenosis (one) or occurred during neurosurgery (two). Twelve patients (eight women and four men) had successful temporary stimulation and proceeded to permanent implantation. The median follow-up time was 12 (range 6-24) months. The mean(s.d.) number of episodes of incontinence decreased from 9·33(7·64) per week at baseline to 2·39(3·69) at last follow-up (P = 0·012). The number of days per week with incontinence and staining decreased significantly (both P < 0·001). Ability to defer defaecation improved from a median of not being able to defer (range 0-1 min) to being able to defer for 5-15 (raBritish Journal of Surgery Volume 92, Issue 6 , Pages 734 – 739.

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