Sacral Nerve Stimulation in Colorectal Surgeries

Introduction

Bladder and bowel dysfunction, such as fecal and urinary incontinence, can be embarrassing for people who suffer from such conditions. Even they may find it difficult and uncomfortable to bring up this condition with their healthcare professionals. More than half of older adults and even some young people suffer from some type of incontinence.

With proper treatment, incontinence can be improved. Among the various advancements in surgical techniques, sacral nerve stimulation (SNS) has emerged as a promising and innovative method for treating certain colorectal disorders. This article explores the role of sacral nerve stimulation in colorectal surgeries, its applications, benefits, and potential challenges.

What Is Sacral Nerve Stimulation?

Sacral nerve stimulation (SNS) is a medical procedure that involves the use of electrical stimulation to modulate the function of the sacral nerves, particularly the sacral nerve roots S2 to S4. These nerves control various pelvic organs, including the bowel, bladder, and pelvic floor muscles.

SNS is a reversible novel treatment primarily used to address certain colorectal disorders, such as fecal incontinence and chronic constipation. This procedure typically involves placing a small device known as a neurostimulator, similar to a pacemaker. This neurostimulator is placed beneath the skin using surgery, usually in the upper buttock or lower abdomen.

The device is connected to a thin, insulated wire known as a lead, which is threaded through the sacral foramen to reach the sacral nerves. When placed, the neurostimulator passes controlled electrical impulses that control the activity of the sacral nerves. SNS aims to regulate and improve bladder and bowel function by influencing the neural signals between the brain and the pelvic organs.

Sacral nerve stimulation is commonly used when conservative treatments, such as medications, lifestyle modifications, and physical therapy, have not been beneficial for conditions like fecal incontinence or chronic constipation. SNS is not a first-line treatment but is often considered when other options have proven ineffective.

How Is a Candidate for Sacral Nerve Stimulation Selected?

Sacral nerve stimulation is generally indicated for patients with refractory rectal incontinence or constipation and for individuals where other therapies (such as lifestyle and dietary changes, medication, or biofeedback) have not worked effectively or have not been tolerated well by the child. Healthcare professionals will evaluate the patient and their medical history to determine if sacral nerve stimulation could be an effective treatment option. As part of this evaluation, the stooling history and prior treatment history will be reviewed. For some patients, additional studies may be needed before recommending the placement of a sacral nerve stimulator.

Indications for sacral nerve stimulation are as follows:

• Fecal Incontinence - Sacral nerve stimulation is used to manage fecal incontinence, a condition characterized by the involuntary loss of bowel control. This can lead to social and emotional distress. The main aim of SNS is to improve sphincter control and reduce episodes of fecal incontinence.

• Chronic Constipation - SNS is also employed for chronic constipation, which involves infrequent bowel movements and difficulty passing stool. It acts by enhancing colonic motility, which can help alleviate symptoms and improve bowel function.

• Overactive Bladder - SNS is also employed in cases of overactive bladder, where abnormal contractions of the bladder muscles cause a frequent and urgent need to urinate. SNS modulates the sacral nerves, which help regulate bladder activity and reduce urinary urgency.

How Is Sacral Nerve Stimulation Performed?

The sacral nerve stimulation procedure is generally performed in two stages:

• Temporary Implantation - During the temporary implantation period, a temporary external stimulator is connected to the lead, and the patient undergoes a test phase to check the effectiveness of sacral nerve stimulation for their specific condition. This temporary setup allows the patient and healthcare provider to determine if the treatment results satisfactorily.

• Permanent Implantation - If the temporary implantation period is successful and significant improvements are observed, the patient may proceed with the permanent implantation of the neurostimulator.

The outpatient procedure to implant the temporary implant takes about 30 to 45 minutes. The procedure to permanently implant the device takes about 15 minutes.

Permanent implantation is a minimally invasive procedure and may include the following steps:

• A small incision is made while the patient is under local anesthesia. Then, a lead wire is implanted next to the sacral nerve, located adjacent to the base of the spine. The sacral nerve controls the action of sphincter muscles.

• After the incision heals, a temporary, battery-powered pacemaker is connected to the lead wire. It sends electrical impulses to the sacral nerve.

• After a successful temporary implantation, the temporary pacemaker is removed, and a permanent pacemaker is implanted under the skin and connected to the lead while the patient is under local anesthesia.

• The simulator is fine-tuned to have maximum benefit for the patient. Although most patients have reported complete continence with this surgery, the aim is a 50 percent improvement in symptoms within a year of surgery.

What Are the Benefits of Sacral Nerve Stimulation?

• Improved Quality of Life - Patients suffering from colorectal dysfunctions such as fecal incontinence or chronic constipation often experience a decline in their quality of life. This procedure offers a chance to improve their condition by addressing the underlying neurological factors contributing to these conditions.

• Reduced Dependence on Medications - Sacral nerve stimulation can reduce the need for long-term medication use, sparing patients from potential side effects and improving overall treatment outcomes.

• Customizable Therapy - The neurostimulator can be customized by programming to deliver different levels of stimulation. This allows for personalized therapy based on the patient's response and needs.

• Minimally Invasive Approach - It is a minimally invasive surgical procedure for sacral nerve stimulation. It often results in shorter recovery times and less postoperative discomfort.

What Are the Risks of Sacral Nerve Stimulation?

The risks of nerve stimulation can be due to the device implanted or the procedure to implant the device. The main risks include mechanical failure or infection related to the device.

Some other side effects may include:

• Technical problems with the neurotransmitter.

• Migration of the device under the skin.

• Infection, skin erosion, or pain at the site of the implant.

• Tickling, numbness, or burning sensation.

• Seroma (accumulation of fluid after surgery).

Conclusion:

Sacral nerve stimulation is a groundbreaking approach to the management of colorectal dysfunctions. It offers hope for patients who are struggling with fecal incontinence and chronic constipation. However, sacral nerve stimulation is not the first-line treatment for colorectal dysfunction; it is only considered when all other treatment modalities do not meet expectations. This innovative therapy exemplifies the ongoing efforts in the medical field to enhance patient outcomes and improve the overall quality of life for individuals facing colorectal challenges.