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World J Gastroenterol. Nov 7, 2013; 19(41): 7048-7054
Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7048
Neuromodulation for fecal incontinence: An effective surgical intervention
Giuseppe Chiarioni, Olafur S Palsson, Corrado R Asteria, William E Whitehead
Giuseppe Chiarioni, Division of Gastroenterology of the University of Verona, Valeggio s/M Hospital, Azienda Ospedaliera Universitaria Integrata di Verona, 37067 Valeggio sul Mincio, Verona, Italy
Giuseppe Chiarioni, Olafur S Palsson, William E Whitehead, Division of Gastroenterology and Hepatology and Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, United States
Corrado R Asteria, Department of Surgery and Orthopedics, General Surgery Unit, Azienda Ospedaliera Carlo Poma di Mantova, Asola General Hospital, 46041 Asola, Mantova, Italy
Author contributions: Chiarioni G, Palsson OS and Whitehead WE contributed equally to the conception, design and drafting of the manuscript; Asteria CR provided criticism and suggestion of high intellectual content.
Supported by National Institute of Diabetes and Digestive and Kidney Disease Grant, No. R01 DK031369
Correspondence to: Giuseppe Chiarioni, MD, Division of Gastroenterology of the University of Verona, Valeggio s/M Hospital, Azienda Ospedaliera Universitaria Integrata di Verona, 37067 Valeggio sul Mincio, Verona, Italy.
Telephone: +39-45-6338548 Fax: +39-45-6338696
Received: June 27, 2013
Revised: August 16, 2013
Accepted: August 28, 2013
Published online: November 7, 2013

Fecal incontinence is a disabling symptom with medical and social implications, including fear, embarrassment, isolation and even depression. Most patients live in seclusion and have to plan their life around the symptom, with secondary impairment of their quality of life. Conservative management and biofeedback therapy are reported to benefit a good percentage of those affected. However, surgery must be considered in the non-responder population. Recently, sacral nerve electrostimulation, lately named neuromodulation, has been reported to benefit patients with fecal incontinence in randomized controlled trials more than placebo stimulation and conservative management, by some unknown mechanism. Neuromodulation is a minimally invasive procedure with a low rate of adverse events and apparently favorable cost-efficacy profile. This review is intended to expand knowledge about this effective intervention among the non-surgically skilled community who deals with this disabled group of patients.

Keywords: Fecal incontinence, Neuromodulation, Sacral nerve stimulation, Biofeedback, Anal sphincter

Core tip: This review summarizes the evidence for neuromodulation of fecal incontinence. Neuromodulation is effective for some patients with fecal incontinence of different etiology unknown mechanism; when analyzed by intent to treat analysis, the median responder rate is 59%. The most common serious adverse event is infection at the site of implant which occurs in about 3% of patients. Cost of treatment is high relative to conservative treatment and biofeedback but seems to be cost-effective when offset by gains in quality-adjusted years. Randomized controlled trials comparing neuromodulation with biofeedback therapy in fecal incontinence are advisable to tailor patients’ management.