Bilateral compared with unilateral sacral nerve stimulation for faecal incontinence: results of a randomized, single‐blinded crossover study. (December 2015)

• Record Type: Journal Article
• Authors: Duelund‐Jakobsen, J.; Buntzen, S.; Lundby, L.; Sørensen, M.; Laurberg, S.
• Is Part Of: Colorectal disease. Volume 17:Number 12(2015)
• Page Start: 1085
• Page End: 1093
• Publication Date: 2015-12
• Subjects: Faecal incontinence -- sacral nerve stimulation -- patient satisfaction; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13111
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: This randomized single‐blinded crossover study aimed to investigate whether bilateral sacral nerve stimulation (SNS) is more efficient than unilateral stimulation for faecal incontinence (FI). Method: Patients with FI who responded during a unilateral test stimulation, with a minimum improvement of 50% were eligible. Twenty‐seven patients who were accepted to enter the trial were bilaterally implanted with two permanent leads and pacemakers. Patients were randomized into three periods of 4 weeks' stimulation including unilateral right, unilateral left and bilateral stimulation. Symptoms scores and bowel habit diaries were collected at baseline and in each study period. A 1‐week washout was introduced between each study period. Results: Twenty‐seven (25 female) patients with a median age of 63 (36–84) years were bilaterally implanted from May 2009 to June 2012. The median number of episodes of FI per 3 weeks significantly decreased from 17 (3–54) at baseline to 2 (0–20) during stimulation on the right side, 2 (0–42) during stimulation on the left side and 1 (0–25) during bilateral stimulation. The Wexner incontinence score improved significantly from a median of 16 (10–20) at baseline to 9 (0–14) with right‐side stimulation, 10 (0–15) with left‐side stimulation and 9 (0–14) with bilateral stimulation. The differences between unilateral right or unilateral left and bilateral stimulation were non‐significant, for FI episodes ( P = 0.3) or for Wexner incontinence score ( P = 0.9). Conclusion: Bilateral SNS therapy for FI is not superior to standard unilateral stimulation in the short term. Equal functional results can be obtained regardless of the side of implantation.