Sacral neuromodulation for fecal incontinence and constipation in adult patients with anorectal malformation-a feasibility study in patients with or without sacral dysgenesis

The aim of this study was to evaluate both the feasibility and effectiveness of sacral neuromodulation for fecal incontinence and constipation in adult patients who had undergone surgical repair of anorectal malformations (ARM). Patients with ARM with or without sacral dysgenesis who presented with fecal incontinence, constipation, or combined symptoms were treated with sacral nerve stimulation (SNS). Success of SNS was assessed by scores preoperatively and after a 3-week test period: Cleveland Clinic Incontinence Score (CCI), Surgical Working Group for Coloproctology (CACP) continence score, German version of the Fecal Incontinence Quality of Life Scale, and Cleveland Clinic Constipation Score (CCCS). The follow-up results of the patients who received a definitive pacemaker were used to evaluate the long-term effect of SNS in patients with ARM. Four patients with fecal incontinence and one patient with constipation (two males, three females; median age 24 years [13; 31]) were treated with SNS between May 2012 and May 2013. Four patients had a normal sacrum; one patient had a sacral dysgenesis. Preoperatively and after the test phase, median CACP continence scores were 8 [1; 10] and 11.5 [3; 16], median CCI 14 [12; 19] and 13 [11; 17], and median Fecal Incontinence Quality of Life Scale improved in all categories. For constipation, CCCSs were 16 and 7. Sacral neuromodulation is a feasible treatment modality for adult patients with ARM with a normally developed sacrum. Patients with sacrum dysgenesis are not suited for SNS because a definitive quadripolar electrode could not be anchored in the absence of a sacral bone.