Sacral nerve stimulation in faecal incontinence associated with an anal sphincter lesion: a systematic review

AIM: The long-term results of sphincteroplasty for faecal incontinence due to an \r\nanal sphincter lesion have been disappointing. Initially sacral nerve stimulation\r\nwas used only in faecal incontinence of neurogenic origin but subsequently the\r\nindications have been extended to other conditions. The aim of this review was to\r\nevaluate sacral nerve stimulation for incontinence in the presence of a sphincter\r\ndefect.\r\nMETHOD: The MEDLINE, Embase and Cochrane Library databases for the period between\r\n1995 and 2011 were searched for studies in English, with no limitations\r\nconcerning the study size or the length of follow-up. The major endpoints were\r\nclinical efficacy, changes in anorectal manometry and quality of life.\r\nRESULTS: Ten reports (119 patients) satisfied the inclusion criteria. The quality\r\nof the studies was low (nine were retrospective, one was prospective). All\r\nreported a lesion of the external anal and/or internal anal sphincter on endoanal\r\nultrasound. A definitive implant was performed on 106 (89%) of the 119 patients\r\nwho underwent a peripheral nerve evaluation test. The weighted average number of \r\nincontinent episodes per week decreased from 12.1 to 2.3, the weighted average\r\nCleveland Clinic Score decreased from 16.5 to 3.8, and the ability to defer\r\ndefaecation, when evaluated, increased significantly. The features at anorectal\r\nmanometry did not change. The quality of life improved significantly in almost\r\nall studies.\r\nCONCLUSION: Sacral nerve stimulation could be a therapeutic option for faecal\r\nincontinence in patients with an anal sphincter lesion. However, the quality of\r\nthe published studies is low. A randomized clinical trial comparing sacral nerve \r\nstimulation with other classical surgical procedures at long-term follow-up,\r\nalthough beset with difficulties, should be conducted.