Sacral nerve stimulation allows for decreased antegrade continence enema use in children with severe constipation

Background Sacral nerve stimulation (SNS) can be beneficial for children with constipation, but no studies have focused on children with constipation severe enough to require antegrade continence enemas (ACEs). Our objective was to evaluate the efficacy of SNS in children with constipation treated with ACE. Methods Using a prospective patient registry, we identified patients < 21 years old who were receiving ACE prior to SNS placement. We compared ACE/laxative usage, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), Fecal Incontinence Severity Index (FISI), and Vancouver Dysfunctional Elimination Syndrome Score (DES) at baseline and progressive follow-up time intervals. Results Twenty-two patients (55% male, median 12 years) were included. Median ACE frequency decreased from 7 per week at baseline to 1 per week at 12 months (p < 0.0001). Ten children (45%) had their cecostomy/appendicostomy closed. Laxative use, GSS, FIQL, and DES did not change. FISI improved over the first 12 months with statistical significance reached only at 6 months (p = 0.02). Six (27%) children experienced complications after SNS that required further surgery. Conclusions In children with severe constipation dependent on ACE, SNS led to a steady decrease in ACE usage with nearly half of patients receiving cecostomy/appendicostomy closure within 2 years. Level of evidence IV.