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SACRAL NERVE STIMULATION AS ALTERNATIVE TREATMENT FOR CHRONIC CONSTIPATION
Alex J. Ky, Chen Wang^*, Matthew Miyasaka
Surgery, Mount Sinai Hospital, New York, NY


Objective: Chronic severe constipation is a common gastrointestinal disorder that can afflicts up to 20% of the population. It is more common in the elderly and female patients. This can be caused by slow transit, pelvic floor dysfunction, and idiopathic. Conservative medical treatments as well as biofeedback have limited success for many patients. As a last resort, colectomies as well as stoma is associated with a higher morbidity and possible mortality. SNS (sacral nerve stimulator) have been shown with limited success at other institutions. We evaluated our experience with SNS for patients with chronic constipation.
Method: a prospective study of patients who failed conservative management of constipation but not ready for a more invasive surgery underwent the test phase before permanent implantation. Patients with greater than fifty percent improvement will then undergo stage 2 permanent neurostimulator implantation. Primary end point were increased frequency of bowel movement without laxatives.
Results: 14 patients (female median age 42) underwent the test stimulation of whom 8(57%) noted improvement of their symptoms and went on to permanent lead placement. Of these, 7 of 8(87%) patients achieved treatment success. After a median 20 (range 4-37) months follow-up, defecation frequency increased from 1.2-4.9. 2 of the 8 patient had improvement in their symptoms of constipation up to 7,15 months but lost its efficacy after 7,15 months despite increased stimulation. Cleveland Clinic score (0=severe to 100=no symptoms) increased from 4-68. 2 of the 6 patient had explantation of the device from late failure.
Conclusion: SNS can be effective for those with intractable constipation that failed conservative medical therapy. It is less invasive than the higher morbidity of abdominal surgical resection but the success rate is only 40% in our small group. Despite the low numbers, it is a minimally invasive way of improve the debilitating condition of chronic constipation.

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