RESUMO
BACKGROUND: Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America. METHODS: A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1-84) months. RESULTS: One hundred and thirty-one patients [119 females, median age of 62.2 (range 19-87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1-84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as "significant". CONCLUSIONS: Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.
Assuntos
Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/terapia , Sacro/inervação , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/estatística & dados numéricos , Eletrodos Implantados , Feminino , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sacro/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Obstructed defecation is one subtype of constipation, and may be due to functional or mechanical causes. Here, we report an unusual cause, never described before, of obstructed defecation due to a large uterine myoma that reverted to normal bowel habits after surgery. The importance of an accurate evaluation of the causes of constipation is highlighted, to recognize potential curable factors.
Assuntos
Impacção Fecal/etiologia , Leiomioma/diagnóstico , Leiomioma/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia , Doença Crônica , Constipação Intestinal/diagnóstico , Constipação Intestinal/etiologia , Defecação/fisiologia , Impacção Fecal/diagnóstico , Feminino , Seguimentos , Humanos , Histerectomia/métodos , Leiomioma/complicações , Espectroscopia de Ressonância Magnética , Manometria/métodos , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Neoplasias Uterinas/complicaçõesRESUMO
La ingestion accidental o intencional de sustancias causticas de uso quimico o industrial, crea una expectativa de gravedad por el pronostico imprevisible de estos pacientes. Los causticos mas comunmente utilizados son los acidos muriatico, sulfurico y nitrico. Entre los anos 1961 y 1968 y desde 1969 hasta 1979, se trataron 20 casos (11 mujeres y 9 varones), propiciando la intervencion quirurgica precoz de los pacientes, adecuando la tecnica a los hallazgos intraoperatorios, con una mortalidad en ambas series del 40%
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Cáusticos , Esôfago , Ferimentos e LesõesRESUMO
La ingestion accidental o intencional de sustancias causticas de uso quimico o industrial, crea una expectativa de gravedad por el pronostico imprevisible de estos pacientes. Los causticos mas comunmente utilizados son los acidos muriatico, sulfurico y nitrico. Entre los anos 1961 y 1968 y desde 1969 hasta 1979, se trataron 20 casos (11 mujeres y 9 varones), propiciando la intervencion quirurgica precoz de los pacientes, adecuando la tecnica a los hallazgos intraoperatorios, con una mortalidad en ambas series del 40%