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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
Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7048
Neuromodulation for fecal incontinence: An effective surgical intervention
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. chiarioni@tin.it
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
Revised: August 16, 2013
Accepted: August 28, 2013
Published online: November 7, 2013
Core Tip
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.