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Sacral neuromodulation for bowel dysfunction: a consensus statement from the Italian group

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Abstract

Background

Representatives from the Italian centers experienced in sacral neuromodulation (SNM) for the treatment of bowel dysfunction met in order to define the current clinical practice in Italy and to produce a consensus statement regarding indications for this therapy and patient management.

Methods

Fifty Italian colonproctologists were asked to complete a questionnaire concerning their clinical practice in SNM (290 questions, grouped within 4 broad areas). Physicians expressed their opinion by completing the questionnaire, assigning to each statement their level of agreement according to the 5-point Likert scale; the data were analyzed by attributing to each expert’s answers a weight proportional to the degree of experience. During a meeting held 2 months later, the critical aspects of the therapy were re-examined and discussions held with the goal of reaching an agreement on controversial topics. The available literature was reviewed.

Results

Patient selection criteria, etiology, diagnostic investigations, test procedures and implantation, follow-up and evaluation of results have been reviewed. The aim was to achieve an algorithm for patient management, showing the place of SNM in the treatment of bowel dysfunction. The approach in case of treatment failure was also discussed.

Conclusions

Analysis of the data collected reveals substantial consensus at the national level concerning all the main points with regard to the therapy. The recommendations expressed in this article can be considered as national guidelines and taken into account by the principal international implantation centers.

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Acknowledgments

We want to thank all the Italian Sacral Neuromodulation Experts who participated in this project by filling out questionnaires, attending meetings and voting on every specific point discussed: Abete Roberta, Napoli; Aliotta Ivano, Catania; Asteria Corrado, Asola (MN); Battaglia Edda, Asti; Brusciano Luigi, Napoli; Caponetto Filippo, Udine; Carriero Alfonso, Montecchio Emilia (RE); Corno Franco, Torino; Cracco Nicola, Negrar (VR); Cuicchi Dajana, Bologna; Dal Corso Herbet, Cuneo; De Nardi Paola, Milano; D’Elia Antonio, Legnano; Dodi Giuseppe, Padova; Ghiselli Roberto, Ancona; Giani Iacopo, Siena; Iachetta Roberto Paolo, Sassuolo; Indinnimeo Marileda, Roma; La Manna Salvatore, Napoli; Landolfi Vincenzo, Solofra (AV); Leopardi Fulvio, Borgo Trento (VR); Lumia Salvatore, Bologna; Martellucci Jacopo, Firenze; Martina Stefania, Vercelli; Martorana Guido, Cefalù (PA); Masin Alessandra, Padova; Menconi Claudia, Pisa; Moraldi Luca, Firenze; Osman Nadine, Pavia; Pagano Claudio, Melegnano; Piazzai Rodolfo, Pergola (PU); Piccolomini Alessandro, Siena; Privitera Antonello, Catania; Racalbuto Agostino, Catania; Rinaldi Marcella, Bari; Santoro Giulio, Treviso; Sarzo Giacomo, Padova; Schiano di Visconte Michele, Conegliano (TV); Stocco Erica, Padova; Vaiana Roberto, Brescia; Villani Roberto Dino, Sassuolo (RE); Volpatto Silvio,Torino; Zanandrea Guido, Monza.

Conflict of interest

The organization of the meetings and the collection of questionnaires were supported by Medtronic Italia Spa.

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Authors and Affiliations

  1. Department of Surgery, Città della Scienza e della Salute, San Giovanni Battista Hospital, Corso Bramante 88, Turin, Italy

    E. Falletto

  2. Gruppo Policlinico di Monza, Division of Colorectal Surgery, Clinica Santa Rita, Colorectal Eporediensis Centre, Vercelli, Italy

    E. Ganio

  3. General Surgery IV, University Hospital of Pisa, Pisa, Italy

    G. Naldini

  4. Department of Surgical Sciences, Catholic University, Rome, Italy

    C. Ratto

  5. General Surgery and Liver Transplantation Units, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Bari, Italy

    D. F. Altomare

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  1. E. Falletto
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  2. E. Ganio
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  3. G. Naldini
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  4. C. Ratto
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  5. D. F. Altomare
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Corresponding author

Correspondence to E. Falletto.

Additional information

This study was conducted on behalf of Italian Sacral Neuromodulation Experts.

The members of the Italian Sacral Neuromodulation Experts are given in “Acknowledgments.”

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Falletto, E., Ganio, E., Naldini, G. et al. Sacral neuromodulation for bowel dysfunction: a consensus statement from the Italian group. Tech Coloproctol 18, 53–64 (2014). https://doi.org/10.1007/s10151-013-1002-2

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