• Héctor Ortiz, Mario de Miguel, Marcella Rinaldi, Fabiola Oteiza, and Donato F Altomare.
• Department of Surgery, Virgen del Camino Hospital, Universidad Pública de Navarra, Pamplona, Navarra, Spain. hhortiz@telefonica.net
• Dis. Colon Rectum. 2012 Aug 1;55(8):876-80.

BackgroundSacral nerve stimulation has been reported as an effective treatment for constipation.ObjectiveThis study aimed to evaluate the therapeutic efficacy of permanent sacral nerve stimulation on the treatment of idiopathic constipation resistant to medical and behavioral management over a median follow-up period of 25.6 (range, 6-96) months.DesignA retrospective review of a prospectively maintained institutional review board-approved database was performed.SettingThe study was performed at 2 tertiary-care European institutions with expertise in sacral nerve stimulation.PatientsPatients were considered eligible if they had had symptoms for at least 1 year and if conservative treatment had failed.InterventionPatients were tested by percutaneous nerve evaluation before the procedure. If this evaluation was successful, patients underwent sacral nerve therapy with an implanted device.Main Outcome MeasurePatients were evaluated by means of a bowel function diary and the Wexner constipation score.ResultsA total of 48 consecutive patients (39 females, median age 50.0 years (range, 17-79 years) entered the study. Twenty-three patients were implanted with a permanent stimulator. On an intention-to-treat basis, only 14 of 48 patients (29.2%) met the definition of a successful outcome at the latest follow-up period (median, 25.6 (range, 6-96) months). The mean Wexner score decreased from 20.2 (SD 3.6) at baseline to 5.8 (SD 4.1) at the latest follow-up examination (p < 0.001). However, 6 of 14 patients (42.8%) were still using laxatives and/or enemas at the last follow-up.LimitationsThe study was limited by the pragmatic approach necessary to evaluate the results in routine clinical practice.ConclusionsThis study shows that sacral nerve stimulation has limited efficacy on an intention-to-treat basis as a routinely recommended therapy for intractable idiopathic constipation.

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