RESUMO
Sacral neuromodulation (SNM) procedure has become a new therapy to treat chronic constipation and fecal incontinence. The surgical procedure is easy and safe. It has a small incision compared with traditional surgery and is mainly used in patients whose traditional treatment was unsuccessful. Chronic constipation is one of the most common digestive symptoms. The quality of life in patients with severe constipation has decreased greatly. Although the incidence of fecal incontinence in China is not as high as that of constipation, it also seriously affects the life of the patients, resulting in a decline in the quality of life. Although the mechanism of SNM is uncertain, with more studies conducted, understanding has become more profound, and the curative effect has been recognized. SNM can improve the symptoms and the quality of life. Many studies have reported SNM treatment. Furthermore, some trials on SNM have been conducted. It is used after colorectal resections to promote symptoms of bowel dysfunction. However, few studies reported regarding SNM for constipation and fecal incontinence in China, and knowledge regarding SNM is limited. In this article, we will mainly discuss SNM in the treatment of chronic constipation and fecal incontinence, and its research progress on the mechanism and method, surgical procedure, effectiveness, complications, postoperative contraindications, and the population who need to pay attention, in order to provide reference for the treatment of SNM in China.
RESUMO
<p><b>OBJECTIVE</b>To assess the efficacy of sacral neuromodulation (SNM) in patients with intractable constipation.</p><p><b>METHODS</b>A total of 7 patients with intractable constipation were treated with pereutaneous test stimulation of the S3 nerve root and were assessed by sacral never stimulation system in our department from January 2013 to January 2014. Four of these 7 patients received operation for constipation before. The efficacy was assessed by bowel habit diary, clinic constipation scores, subjective questionnaire and clinical signs.</p><p><b>RESULTS</b>The constipation symptoms were improved significantly in all the 7 patients. The frequency and volume of defecation per week were increased obviously, and the average urine was increased. Six patients underwent permanent implantation of the SNS system. After a median 4 months follow-up, the defecation frequency increased from 0.6 ± 0.5 to 8.0 ± 2.5 per week (P<0.01), and the defecation time decreased from (22.9 ± 11.5) to (3.7 ± 0.8) min (P<0.01). The Cleveland clinic constipation score decreased from 24.6 ± 4.2 to 9.0 ± 0.9 (P<0.01), and the visual analogue scale(VAS) score increased from 8.1 ± 0.9 to 82.5 ± 5.2 (P<0.01).</p><p><b>CONCLUSION</b>SNM is a clinically efficacious, minimally invasive and safe new technique, which offers an alternative treatment for the patients with intractable constipation resistant to conservative treatment, especially for the patients refractory to traditional operations.</p>