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2. Long-Term Results of Antegrade Colonic Enema in Adult Patients: Assessment of Functional Results

Author

Worsøe, J., Christensen, P., Krogh, K., Buntzen, S., and Laurberg, S.

Abstract

Abstract: Purpose: This retrospective study reviewed long-term results in a large group of adult patients treated with antegrade colonic enema and antegrade colonic enema combined with a colostomy. Methods: Retrospective chart review identified 80 patients (64 females, mean age 51) surgically treated between 1993 and 2007 for fecal incontinence or constipation. Surgical treatments included 69 appendicostomies, 13 tapered ileum, 3 cecal tube, and 25 appendicostomy/neoappendicostomy combined with a colostomy. A 44-item questionnaire was mailed considering bowel regimen, complications, bowel function, social function, and quality of life. Results: Sixty-nine patients were available for follow-up (mean follow-up, 75 months). Thirty patients (38 percent) had surgical complications. Forty-three patients (62 percent) were still performing antegrade continence enema and 8 patients (12 percent) no longer needed it. Accordingly, treatment was successful in 51 patients (74 percent). Twenty-seven patients (63 percent) had side effects. Evaluation of bowel function, social function, and quality of life all showed significant improvement. Antegrade continence enema was successful in patients with neurologic disabilities (67 percent), anorectal injury (53 percent), idiopathic fecal incontinence (50 percent), and idiopathic fecal constipation (42 percent). Antegrade continence enema was successful in patients with constipation, incontinence, and mixed symptoms. Results did not differ between appendicostomy, neoappendicostomy, and the combined appendicostomy/neoappendicostomy and colostomy. Conclusion: Long-term results were favorable in most patients treated with antegrade continence enema for fecal incontinence or constipation.

Published
2024
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31. Changing paradigm of sacral neuromodulation and external anal sphincter repair for faecal incontinence in specialist centres

Author

Ong, K., primary, Bordeianou, L., additional, Brunner, M., additional, Buntzen, S., additional, Collie, M.H.S., additional, Hanly, A., additional, Hunt, C. W., additional, Matzel, K. E., additional, O’Connell, P. R., additional, Rydningen, M., additional, Savitt, L., additional, Totaro, A., additional, Vaizey, C. J., additional, and Maeda, Y., additional

Published
2020
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47. Changing paradigm of sacral neuromodulation and external anal sphincter repair for faecal incontinence in specialist centres.

Author

Ong, K., Bordeianou, L., Brunner, M., Buntzen, S., Collie, M.H.S., Hanly, A., Hunt, C. W., Matzel, K. E., O'Connell, P. R., Rydningen, M., Savitt, L., Totaro, A., Vaizey, C. J., and Maeda, Y.

Subjects
ANUS, ARTIFICIAL sphincters, SACRAL nerves, SPHINCTERS, NEURAL stimulation, NEUROMODULATION
Abstract

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. Method: This was a multi‐centre retrospective study of patients who had undergone either sacral neuromodulation (SNM) or delayed sphincter repair or sphincteroplasty (SR) as a primary surgical intervention for FI in five centres in Europe and one in the United States. The flow of patients according to the intervention, sustainability of the treatment at a minimum follow‐up of 5 years, complications and requirement for further interventions were recorded. Results: A total of 461 patients (median age 56 years, range 24–90 years, 41 men) 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, re‐siting or removal). At the time of last follow‐up 203 patients (71.4%) continued to use SNM. Among SR patients, 30 (16.9%) had complications, most notably wound infection (22, 12.4%). During follow‐up 32 patients (18.1%) crossed over to SNM. Comparing two 4‐year periods (2000–2003 and 2007–2010), the proportion of patients operated on who had a circumferential sphincter defect of less than 90° was 48 (68%) and 45 (46%), respectively (P = 0.03), while those who had SNM as the primary intervention increased from 29% to 89% (P < 0.05). Conclusion: The paradigm of surgical intervention for FI has changed with increasing use of SNM. [ABSTRACT FROM AUTHOR]

Published
2021
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49. Improved longevity and efficacy of sacral nerve stimulation by simple adjustments at follow‐up.

Author

Duelund‐Jakobsen, J., Buntzen, S., Laurberg, S., and Lundby, L.

Subjects
*SACRAL nerves, *NEURAL stimulation, *PATIENT satisfaction, *LONGEVITY, *CARDIAC pacemakers, *SENSORY stimulation
Abstract

Aim: Sacral nerve stimulation (SNS) for faecal incontinence (FI) at subsensory amplitudes as low as 50% of the sensory threshold has been found to be effective at 3 months' follow‐up. Furthermore, alternative pacemaker settings may improve functional outcome in patients with suboptimal treatment efficacy. In this work we aim to explore if sub‐sensory stimulation as low as 50% of sensory threshold is effective at 1‐year follow‐up. We also aimed to investigate if 31 Hz (frequency) or 90 µs (pulse width) stimulation improved treatment efficacy in dissatisfied patients. Method: All patients in whom the stimulation was effective in controlling FI (satisfied group) were encouraged to have the stimulation amplitude reduced. Those in whom the device was less effective (dissatisfied group) were offered alternative frequency settings or pulse width (31 Hz or 90 µs). Patients were follow‐up after 12 months and evaluated by a visual analogue scale (VAS) for patient satisfaction, the Cleveland Clinic Continence Score (CCCS), Rockwood Faecal Incontinence Quality of Life Scale (QoL) and a bowel habit diary. Results: Two hundred and nineteen patients were contacted, with a response rate of 71% (n = 155). Those who were successfully contacted comprised 110 (71%) patients classed as satisfied and 45 (29%) as dissatisfied. Seventy‐five (68%) of the satisfied patients agreed to have their stimulation amplitude reduced. At 1‐year follow‐up the median amplitude had reduced from 1.5 V [interquartile range (IQR) 0.85–2.0 V] to 0.75 V (IQR 0.45–1.4 V) (P‐value < 0.001) representing an overall reduction of 39% (6.6–62.5%). There were no significant differences in VAS, CCCS or QoL despite subsensory stimulation at 1‐year follow‐up. In 28% of the dissatisfied patients alternative pacemaker settings improved VAS to satisfactory levels. Conclusion: Subsensory stimulation is as effective as stimulation at or above the sensory threshold. High‐frequency stimulation (31 Hz) can improve functional outcome in patients with loss of efficacy. [ABSTRACT FROM AUTHOR]

Published
2020
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