Objectives and Study

Sacral nerve stimulation (SNS) is being increasingly recommended in children with refractory constipation. The sparse pediatric data on the efficacy of SNS in constipation is conflicting, and this has led to ambiguity over the use of SNS for treating children with constipation.

The aim of our study is to determine the outcomes of pediatric patients with idiopathic constipation who underwent SNS placement.

Methods

Electronical medical records of all patients with idiopathic constipation who had SNS placed for refractory idiopathic constipation, were reviewed. Data retrieved included demographics, symptoms, imaging, colonic manometry results, treatment, and complications.

Results

Twenty patients (60% females, median age 10.2 years (IQR: 7.5, 14.4) with intractable idiopathic constipation and SNS placement met inclusion criteria. Mean follow-up was of 22.7 months (range 7-42) after SNS placement. Colonic manometry was abnormal in 6 (30%) with no high-amplitude propagating contractions in the distal colon. Six (30%) patients underwent SNS placement after cecostomy, while 2 (10%) patients had cecostomy placement (for antegrade enemas - ACE) after SNS placement. Six patients (30%) had sigmoidectomy (2 of them post SNS placement). Three (15%) patients had their SNS removed due to failure to respond. Number of bowel movements increased in 4 (20%), stool consistency improved in 1 (5%), soiling episodes resolved in 1 (5%) and decreased in 7 (35%) patients. Laxatives and enemas were reduced in 10 (50%) patients. One (16.6%) patient with SNS placement after cecostomy had increase in bowel movements and 2 (33.3%) had improvement in soiling. SNS placement did not cause improvement in patients with prior sigmoid resection.

Conclusions

This is the largest pediatric study with the longest follow-up data on the efficacy of SNS in refractory idiopathic constipation. Despite concomitant antegrade enemas in 8 (40%), and sigmoid resection in 6 (30%), placement of SNS did not uniformly improve outcomes of idiopathic constipation in children.