Can Sacral Nerve Stimulation (SNS) Also Treat Constipation? | Peter L. Lu, Lindsey Asti, Daniel L. Lodwick, et al. | Journal of Pediatric Surgery | 22 patients with constipation and requiring enema received SNS | What Improved | Need for enema from 7 to 1 times/wk (p < 0.0001) | Cecostomy/appendicostomy closed in 45% of the pts. | Fecal Incontinence Severity Index improved at 6 months (p = 0.02) | What Did not Improve | Laxative use | Fecal Incontinence Quality of Life Scale | Vancouver Dysfunctional Elimination Syndrome Score | Gastrointestinal Symptom Scale | Complications: 1 pt required removal for lead displacement and 6 lower extremity numbness resolved with repositioning of SNS. | SNS can decrease the need for enema usage in severe constipation pts. | visual abstract created by Abdulraouf Lamoshi
Sacral nerve stimulation allows for decreased antegrade continence enema use in children with severe constipation
Infographic · Oct 2018 · 1 min read
In brief
In brief
Prospective registry study of 22 children with severe constipation requiring antegrade continence enemas found sacral nerve stimulation reduced ACE frequency from 7 to 1 per week at 12 months, with 45% achieving cecostomy/appendicostomy closure. Complication rate was 27%, requiring additional surgery.
- SNS reduced ACE frequency from 7/week to 1/week at 12 months in children with severe constipation (p<0.0001)
- 45% of patients achieved cecostomy/appendicostomy closure after SNS, demonstrating potential for device removal
- Quality of life measures (GSS, FIQL, DES) remained stable, suggesting SNS maintains baseline function while reducing ACE dependence
- 27% complication rate requiring reoperation indicates SNS is not without surgical risk in this population
- SNS offers alternative management for ACE-dependent children, potentially avoiding long-term stoma maintenance
Written by the GCMD Library team from the infographic.
A conference-style poster with mint green background divided into two columns. Left column (dark blue) shows improvements with a happy face icon, right column (cyan) shows non-improvements with a sad face icon. Top section displays title, authors, and study population with an SNS device illustration. Bottom includes complications note and conclusion in red text.
Background
Sacral nerve stimulation (SNS) can be beneficial for children with constipation, but no studies have focused on children with constipation severe enough to require antegrade continence enemas (ACEs). Our objective was to evaluate the efficacy of SNS in children with constipation treated with ACE.
Methods
Using a prospective patient registry, we identified patients <21 years old who were receiving ACE prior to SNS placement. We compared ACE/laxative usage, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), Fecal Incontinence Severity Index (FISI), and Vancouver Dysfunctional Elimination Syndrome Score (DES) at baseline and progressive follow-up time intervals.
Results
Twenty-two patients (55% male, median 12 years) were included. Median ACE frequency decreased from 7 per week at baseline to 1 per week at 12 months (p < 0.0001). Ten children (45%) had their cecostomy/appendicostomy closed. Laxative use, GSS, FIQL, and DES did not change. FISI improved over the first 12 months with statistical significance reached only at 6 months (p = 0.02). Six (27%) children experienced complications after SNS that required further surgery.
Conclusions
In children with severe constipation dependent on ACE, SNS led to a steady decrease in ACE usage with nearly half of patients receiving cecostomy/appendicostomy closure within 2 years.
Level of evidence
IV.