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Sacral neuromodulation for fecal incontinence in Latin America: initial results of a multicenter study

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Abstract

Background

Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America.

Methods

A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1–84) months.

Results

One hundred and thirty-one patients [119 females, median age of 62.2 (range 19–87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1–84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as “significant”.

Conclusions

Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.

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Acknowledgements

We wish to acknowledge the following surgeons for including patients in the database: Omar Vergara-Fernadez, MD, Hospital Medica Sur, Mexico City, Mexico; Quintin H. González-Contreras, MD, Hospital Ángeles del Pedregal, Mexico City, Mexico; Rafael Sánchez Morett, MD, Hospital Angeles Santa Mónica, Mexico City, Mexico, Juan Pablo Muñoz, MD, Department of Surgery, Hospital de Gastroenterologia, Buenos Aires, Argentina and Rubén Miravalle,MD, Buenos Aires,Argentina. We also wish to thank Elektra McDermott for her assistance in the editing and preparation of this manuscript.

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Authors and Affiliations

  1. Department of Anorectal Physiology of Rio de Janeiro, CEPEMED, Rua Visc.de Pirajá 414/812, Ipanema, Rio de Janeiro, 22410-002, Brazil

    L. Oliveira

  2. Colorectal Surgery, Centro Medico ABC Universidad Panamericana, Alvaro Obregon, Mexico City, Mexico

    G. Hagerman

  3. Colorectal Clinic of Puerto Rico, San Juan, PR, USA

    M. L. Torres

  4. Department of Surgery, Hospital de Gastroenterologia, Buenos Aires, Argentina

    C. M. Lumi

  5. Department of Surgery, Fundacion Santa Fe de Bogota, Bogotá, Colombia

    J. A. C. Siachoque

  6. Coloproctology Unit, Department of Surgery, Clinical del Country, Bogotá, Colombia

    J. C. Reyes

  7. Hospital Militar de Ciudad de Mexico, Mexico City, Mexico

    J. Perez-Aguirre

  8. Hospital Central Militar Universidad del Ejercito y Fuerza, Cuauhtémoc, Mexico

    J. C. Sanchez-Robles & V. H. Guerrero-Guerrero

  9. Universidade Federal do Ceará, Fortaleza, Brazil

    S. M. Regadas

  10. Hospital Santa Rita de Maringa, Maringá, Parana, Brazil

    V. G. Filho

  11. Colorectal Surgery, Hospital Universitario Austral, Buenos Aires, Argentina

    G. Rosato

  12. Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    E. Vieira

  13. Hospital Federal da Lagoa, Rio de Janeiro, Brazil

    L. Marzan

  14. Anorectal Physiology Department, Gastroclínica Cascavel, Cascavel, Parana, Brazil

    D. Lima

  15. Universidad de los Andes, Bogotá, Colombia

    E. Londoño-Schimmer

  16. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    S. D. Wexner

  17. Colorectal Surgery, Casa de Saúde São José, Rua Macedo Sobrinho, 21 – Humaitá, Rio de Janeiro, RJ, Brazil

    L. Oliveira

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  1. L. Oliveira
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  2. G. Hagerman
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  3. M. L. Torres
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  4. C. M. Lumi
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  5. J. A. C. Siachoque
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  7. J. Perez-Aguirre
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  8. J. C. Sanchez-Robles
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  9. V. H. Guerrero-Guerrero
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  11. V. G. Filho
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  13. E. Vieira
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  14. L. Marzan
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  15. D. Lima
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  16. E. Londoño-Schimmer
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  17. S. D. Wexner
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Contributions

All authors: Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to L. Oliveira.

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Conflict of interest

Wexner: Paid consultant for Medtronic. Oliveira, Hagerman, Torres, Lumi, Marzan: Paid consultant for Medtronic. Carrera Siachoque, Reyes, Perez-Aguirre, Sanchez-Robles, Guerrero, Regadas, Gaburgio Filho, Rosato, Vieira, Lima, Londoño-Schimmer: None.

Human and animal rights

All procedures were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethics approval

This study was exempt from Ethics approval from the participating institutions.

Informed consent

All patients gave signed informed consents prior to their surgery.

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Oliveira, L., Hagerman, G., Torres, M.L. et al. Sacral neuromodulation for fecal incontinence in Latin America: initial results of a multicenter study. Tech Coloproctol 23, 545–550 (2019). https://doi.org/10.1007/s10151-019-02004-y

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