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Background: Numerous studies advocate the short-term benefits of sacral nerve stimulation for fecal incontinence, but there has been a paucity of studies on longer-term outcomes., Objective: The objective of this study was to report the long-term outcome of sacral nerve stimulation performed for fecal incontinence at a single institution., Patients and Design: Between January 2004 and May 2007, 53 patients underwent definitive sacral nerve stimulation for fecal incontinence at our institution. Prospectively recorded baseline information, including Wexner incontinence scores and standard short-form (SF-12) health survey scores, were compared with scores at follow-up., Results: Forty-one patients were available for long-term follow-up with a mean duration of 51 months. The median Wexner score decreased from a baseline of 11.5 (range, 3.0-18.0) to 8.0 (range, 0.0-18.0) at follow-up. The mean difference in Wexner score was 2.7 (P < .001). There was no statistically significant change in SF-12 physical scores, but a small but highly significant change occurred in SF-12 mental scores. The median SF-12 mental domain score was 49.5 (range, 15.0-62.1) at baseline, and 57.0 (range, 20.0-64.0) at follow-up, with a mean difference of 4.5 (P = .006). Subgroup analysis performed comparing patients with or without prior intersphincteric silicon biomaterial implants demonstrated a mean difference in Wexner score of -3.5 (no implant) vs 0.0 (previous implant), with P < .09 (not statistically significant)., Conclusions: Sacral nerve stimulation results in a statistically significant improvement in fecal incontinence scores in the long term.

Background: Several techniques have been described in the literature for skin closure following stoma reversal. We describe the "gunsight skin closure" technique and highlight its potential advantages., Method: Four triangles of skin are excised to enlarge the skin incision. This increases exposure for mobilization of the bowel. The resulting skin wound is approximated with a pursestring suture to give a small, neat scar that allows some central drainage. The final wound resembles a gunsight., Conclusion: This method of skin closure allows increased surgical exposure, facilitates creation of a subsequent stoma at the same site, simplifies wound care, and gives a neat cosmetic result.

Diverticulitis in the young is often regarded as a specific entity. Resection after a single attack because of a more "virulent" course of the disease has been accepted as conventional wisdom. The evidence for such a recommendation and the place of elective surgery was reviewed by a search of Medline, PubMed, Embase, and the Cochrane library for articles published between January 1965 and March 2008 using the terms diverticular disease and diverticulitis. Publications had to give specific information on at least ten younger patients (age