Changing paradigm of sacral neuromodulation and external anal sphincterrepair for faecal incontinence in specialist centres.

Ong, Kelly; Bordeianou, Liliana; Brunner, Maximilian; Buntzen, Steen; Collie, Mhairi; Hanly, Ann; Hunt, Cameron W; Matzel, Klaus E; Ronan O'Connell, P; Rydningen, Mona; Savitt, Lieba; Totaro, Annarita; Vaizey, Carolynne J; Maeda, Yasuko

AIM The aim of this study was to determine whether the paradigm of surgical intervention for faecal incontinence (FI) has changed between 2000 and 2013. METHODS This was a multi-centre retrospective study of patients who had undergone either sacral neuromodulation (SNM) or delayed sphincter repair or sphincteroplasty (SR) as primary surgical intervention for FI in five centres in Europe and one in USA. Flow of patients according to the intervention, sustainability of the treatment at minimum5-year follow-up, complications and requirement for further interventions were recorded. RESULTS 461 patients (median age 56, range 24-90, 41 male) had either SNM or SR as an index operation during the study period (SNM: 284 (61.6%), SR:177 (38.4%)).Among SNM patients, there were 169 revisional operations (change of battery and/or lead, resiting or removal). 203 patients (71.4%) continue to use SNM at the time of last follow-up. Among SR patients, 30 (16.9%) had complications, most notably wound infection (22, 12.4%). 32 patients (18.1%) crossed over to SNM during follow-up. Comparing two 4-year periods (2000-2003 and 2007-2010), the proportion of patients operated who had a circumferential sphincter defect of less than 90 degrees was 48 (68%) and 45 (46%), respectively (p=0.03) while those who had SNM as primary intervention increased from 29% to 89% (p<0.05). CONCLUSION The paradigm of surgical intervention for faecal incontinence has changed with increasing use of SNM.