M.D. Cardenas1, R. Hollis1, S. Canizares2, C. Esquetini2, A. Zimmern1 1Northwell, Department Of Surgery At Zucker School Of Medicine, New Hyde Park, NY, USA 2Universidad San Francisco de Quito, Departamento De Medicina, Quito, PICHINCHA, Ecuador
Introduction:
Fecal incontinence is a common complication following ileal pouch-anal anastomosis (IPAA) and can severely impact quality of life. Approximately one half to two thirds of patients undergoing a redo IPAA experience incontinence or soiling. This progressive condition may be treated by bulking agents and pelvic floor physiotherapy, but many cases are refractory to conservative measures. However, minimally invasive neuromodulatory techniques can enhance the resting and squeezing pressures of the anal sphincter and potentially improve continence. This case series aims to explore the potential benefits and role of sacral nerve stimulator (SNS) following IPAA and redo IPAA.
Methods:
Patient charts were reviewed from March to July 2024 to identify patients with IPAA or redo IPAA and SNS. Patient demographics and clinical course were evaluated.
Results:
We identified four patients undergoing SNS following IPAA or redo IPAA. IPAAs were performed for inflammatory bowel disease, such as ulcerative colitis, and neuronal intestinal dysplasia. Age at IPAA ranged from 26 to 71 years. Redo IPAA, when performed, occurred between 5 and 22 years after the initial IPAA. Indications included incontinence and obstructive episodes. Management for incontinence lasted one to two years before placement of SNS. Initial therapies included bulking agents, fiber, kenalog injection, antidiarrheals (imodium, lomotil, and tincture of opium), acupuncture, and pelvic floor physiotherapy. All patients reported improvements in quality of life after SNS placement. Quality of life improvements related to a decreased need for medications and improvement in the severity and frequency of incontinence episodes, which were reported at the one month follow up visit (Table1).
Conclusion:
Since SNS has successfully treated refractory fecal incontinence following IPAA, it is reasonable to explore the effectiveness of SNS in the more complex population of patients undergoing redo IPAA. We present a series of patients with IPAA and redo IPAA who have been successfully treated with SNS after other therapeutic options failed. These results suggest that SNS is an effective and safe alternative for patients with refractory symptoms, significantly enhancing quality of life. However, evidence supporting the use of SNS after redo IPAA remains limited. Larger studies are needed to better understand the pathophysiology of incontinence after redo IPAA, the efficacy of SNS, and patient selection for this intervention.