Skip to main content

Advertisement

SpringerLink
Log in

Sacral nerve stimulation for faecal incontinence following a rectosigmoid resection for colorectal cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Following recto-sigmoid resection some patients may become faecally incontinent and remain so despite conservative treatment. This multicentre prospective study assessed the use of sacral nerve stimulation (SNS) in this group.

Methods

All patients had more than or equal to 4 days of faecal incontinence for solid or liquid stools over a 21-day period following recto-sigmoid resection for colorectal carcinoma. The operation had to have been deemed curative. They had to have failed pharmacological and biofeedback treatment.

Results

Three male patients met these criteria. One had had a colo-anal and two a colo-rectal anastomosis for rectal carcinoma. All patients had intact internal and external anal sphincters. Two patients had a successful temporary stimulation period and proceeded to permanent implantation. Pre-operative symptom duration was 1 year in the permanently implanted patients. They were followed up for 12 months. SNS improved the number of faecally incontinent episodes in both patients. Ability to defer was improved in both patients from 0–5 min to 5–15 min. The faecal incontinence-specific ASCRS quality of life assessment improved in all four subcategories.

Conclusion

This study demonstrates that SNS may be effective in the treatment of patients with faecal incontinence following recto-sigmoid resection if conservative treatment has failed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig 2

Similar content being viewed by others

References

  1. Norton C, Kamm MA (1999) Outcome of biofeedback for faecal incontinence. Br J Surg 86:1159–1163

    Google Scholar 

  2. Ho YH (2001) Postanal sphincter repair for anterior resection anal sphincter injuries: report of three cases. Dis Colon Rectum 44:1218–1220

    Google Scholar 

  3. Matzel KE, Kamm MA, Stosser M, Baeten CGMI, Christiansen J, Madoff R, Mellgren A, Nicholls RJ, Rius J, Rosen H, The 301 Study Group (2004) Sacral nerve stimulation for faecal incontinence: a multicentre study. Lancet 363:1270–1276

    Google Scholar 

  4. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127

    Google Scholar 

  5. Vaizey CJ, Kamm MA, Turner IC, Nicholls RJ, Woloszko J (1999) Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut 44:407–412

    Google Scholar 

  6. Malouf AJ, Vaizey CJ, Nicholls RJ, Kamm MA (2000) Permanent sacral nerve stimulation for fecal incontinence. Ann Surg 232:143–148

    Google Scholar 

  7. Matzel KE, Stadelmaier U, Hohenfellner M, Hohenberger W (2001) Chronic sacral spinal nerve stimulation for faecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum 44:59–66

    Google Scholar 

  8. Ganio E, Realis A, Clerico G, Trompetto M (2001) Sacral nerve stimulation for treatment of faecal incontinence. Dis Colon Rectum 44:619–628

    Google Scholar 

  9. Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R (2001) Sacral nerve stimulation as a treatment for faecal incontinence. Gastroenterology 121:536–541

    Google Scholar 

  10. Leroi AM, Michot F, Grise P, Denis P (2001) Effect of sacral nerve stimulation in patients with faecal and urinary incontinence. Dis Colon Rectum 44:779–789

    Google Scholar 

  11. Kenefick NJ, Vaizey CJ, Nicholls RJ, Cohen R, Kamm MA (2002) Sacral nerve stimulation for faecal incontinence due to systemic sclerosis. Gut 51:881–883

    Google Scholar 

  12. Kenefick NJ, Vaizey CJ, Cohen RG, Nicholls JR, Kamm MA (2002) Medium-term results of sacral nerve stimulation for faecal incontinence. Br J Surg 89:896–901

    Google Scholar 

  13. Matzel KE, Bittorf B, Stadelmaier U, Hohenberger W (2003) Sacral nerve stimulation in the treatment of faecal incontinence. Chirurg 74:26–32

    Google Scholar 

  14. Habib HN (1967) Experience and recent contributions in sacral nerve stimulation for voiding in both human and animal. Br J Urol 39:73–83

    Google Scholar 

  15. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1995) Permanent electrostimulation of sacral spinal nerves with an implantable neurostimulator in treatment of fecal incontinence. Chirurg 66:813–817

    Google Scholar 

  16. Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ (2000) Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 43:298–302

    Google Scholar 

  17. Law PJ, Bartram CI (1989) Anal endosonography: technique and normal anatomy. Gastrointest Radiol 14:349–353

    Google Scholar 

  18. Jenkinson C, Coulter A, Wright L (1993) Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. Br Med J 306:1437–1440

    Google Scholar 

  19. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16

    Google Scholar 

  20. Bosch JL, Groen J (1995) Sacral (S3) segmental nerve stimulation as a treatment for urge incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neural prosthesis. J Urol 154:504–507

    Google Scholar 

  21. Siegel SW (1992) Management of voiding dysfunction with an implantable neuroprosthesis. Urol Clin North Am 19:163–170

    Google Scholar 

  22. Matzel KE, Bittorf B, Gunther K, Stadelmaier U, Hohenberger W (2003) Rectal resection with low anastomosis: functional outcome. Colorectal Dis 5:458–464

    Google Scholar 

  23. Matzel KE, Stadelmaier U, Muehldorfer S, Hohenberger W (1997) Continence after colorectal reconstruction following resection: impact of level of anastomosis. Int J Colorectal Dis 12:82–87

    Google Scholar 

  24. Farouk R, Duthie GS, Lee PW, Monson JR (1998) Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up. Dis Colon Rectum 41:888–891

    Google Scholar 

  25. Karanjia ND, Schache DJ, Heald RJ (1992) Function of the distal rectum after low anterior resection for carcinoma. Br J Surg 79:114–116

    Google Scholar 

  26. Otto IC, Ito K, Ye C, Hibi K, Kasai Y, Akiyama S, Takagi H (1996) Causes of rectal incontinence after sphincter-preserving operations for rectal cancer. Dis Colon Rectum 39:1423–1427

    Google Scholar 

  27. Miller AS, Lewis WG, Williamson ME, Holdsworth PJ, Johnston D, Finan PJ (1995) Factors that influence functional outcome after coloanal anastomosis for carcinoma of the rectum. Br J Surg 82:1327–1330

    Google Scholar 

  28. Jehle EC, Haehnel T, Starlinger MJ, Becker HD (1995) Level of the anastomosis does not influence functional outcome after anterior rectal resection for rectal cancer. Am J Surg 169:147–152

    Google Scholar 

  29. Williamson ME, Lewis WG, Holdsworth PJ, Finan PJ, Johnston D (1994) Decrease in the anorectal pressure gradient after low anterior resection of the rectum. A study using continuous ambulatory manometry. Dis Colon Rectum 37:1228–1231

    Google Scholar 

  30. Lewis WG, Martin IG, Williamson ME, Stephenson BM, Holdsworth PJ, Finan PJ, Johnston D (1995) Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma? Dis Colon Rectum 38:259–263

    Google Scholar 

  31. Matzel KE, Stadelmaier U, Bittorf B, Hohenfellner M, Hohenberger W (2002) Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int J Colorectal Dis 17:430–434

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. St. Mark’s Hospital, London, UK

    Michael E. D. Jarrett & Michael A. Kamm

  2. Department of General Surgery, University Hospital Erlangen, Erlangen, Germany

    Klaus E. Matzel

  3. Medtronic Europe Sarl, Tolochenaz, Switzerland

    Michael Stösser

  4. Department of Surgery, Herlev Hospital, Herlev, Denmark

    John Christiansen

  5. Department of General Surgery, Danube Hospital/ SMZ-Ost, Vienna, Austria

    Harald Rosen

Authors
  1. Michael E. D. Jarrett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus E. Matzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Stösser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harald Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael A. Kamm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Kamm.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jarrett, M.E.D., Matzel, K.E., Stösser, M. et al. Sacral nerve stimulation for faecal incontinence following a rectosigmoid resection for colorectal cancer. Int J Colorectal Dis 20, 446–451 (2005). https://doi.org/10.1007/s00384-004-0729-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-004-0729-7

Keywords

Search

Navigation