The following is a summary of “Does Rectoanal Intussusception Limit Improvements in Clinical Outcome and Quality of Life After Sacral Nerve Stimulation for Fecal Incontinence?,” published in the June 2023 issue of Diseases of the Colon and Rectum by Dawes et al.
Sacral nerve stimulation is a therapeutic approach for managing severe, medically resistant fecal incontinence. However, its application in individuals with anatomical irregularities is debated within the medical community. This study sought to ascertain whether individuals with rectoanal intussusception experience comparable advantages from the implantation of medical devices as individuals without rectoanal intussusception—a retrospective analysis of a database maintained prospectively. Demographic characteristics and clinical information were gathered for every patient, encompassing preoperative pelvic floor assessment. The defecography underwent reanalysis in a blinded fashion. Preoperative rectoanal intussusception was identified using the Oxford system, distinguishing between grade III-IV and non-grade V cases—all individuals experiencing sacral nerve stimulation for fecal incontinence from July 2011 to July 2019.
The Cleveland Clinic Florida assessed the Incontinence/Wexner Scores, Fecal Incontinence Severity Indices, and Fecal Incontinence Quality of Life Indices after 1 year. During the study period, a total of 169 patients underwent sacral nerve stimulation for the treatment of fecal incontinence. The mean age observed was 60.3 years, with a majority of 91% being of the female gender. About 46 individuals (27.2%) exhibited concurrent rectoanal intussusception, with 38 individuals (22.5%) classified as grade III and eight individuals (4.7%) classified as grade IV. Before the surgical procedure, the patients provided data regarding their accident frequency, averaging 10.8 weekly incidents.
Additionally, they reported a Wexner score of 15.7. Notably, no discernible distinctions were observed between patients with and without rectoanal intussusception regarding accident frequency (P = 0.22) and Wexner score (P = 0.95). At 1 year postoperative, the mean Wexner score was recorded as 9.5.
There was no significant difference observed in the postoperative Wexner scores (10.4 vs. 9.2, P = 0.23) or the rate of improvement over time between patients with and without rectoanal intussusception (–6.7 vs. –5.7, P= 0.40). Likewise, there was no discernible disparity in the quality of life or frequency of incontinence between liquid or solid fecal matter. The study was conducted at a single medical facility with a moderate number of participants, and there were some missing responses in the survey. Concomitant rectoanal intussusception does not seem to impact clinical outcomes or quality of life following sacral nerve stimulation for fecal incontinence. Patients presenting with fecal incontinence and rectoanal intussusception may be deemed suitable candidates for the placement of sacral nerve stimulation.
