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Keywords
Despite the increasing incidence and prevalence of Crohn’s Disease (CD), no curative options exist and treatment remains complex. While therapy has mainly focused on medical approaches in the past, growing evidence reveals that in cases of limited inflammation, surgery can suffice as an alternative primary treatment. We retrospectively assessed the disease course and outcomes of 103 patients with terminal Ileitis who underwent primary surgery (n = 29) or received primary medical treatment followed by surgery (n = 74). Primary endpoint was the need for immunosuppressive medication after surgical treatment (ileocecal resection, ICR) during a two-years follow-up. Rates for laparoscopic ICR were enhanced in case of early surgery, but no differences were seen for postoperative complications. In case of immunosuppressive medication, patients with ICR at an early state of disease needed significantly less anti-inflammatory medication during the two-year postoperative follow-up compared to patients who were primarily treated medically. Furthermore, in a subgroup analysis for patients with localized ileocecal disease manifestation, early surgery consistently resulted in a decreased amount of medical therapy postoperatively. In conclusion primary ICR is safe and effective in patients with limited CD, and the need for immunosuppressive medication during the postoperative follow-up is low compared to patients receiving surgery at a later stage of disease.
Purpose
Sacral nerve stimulation is an effective treatment for patients suffering from fecal incontinence. However, less is knownabout predictors of success before stimulation. The purpose of this study was to identify predictors of successful sacral nervestimulation in patients with idiopathic fecal incontinence.
Methods
Consecutive female patients, receiving peripheral nerve evaluation and sacral nerve stimulation between September2008 and October 2014, suffering from idiopathic fecal incontinence were included in this study. Preoperative patient’scharac-teristics, anal manometry, and defecography results were collected prospectively and investigated by retrospective analysis. Mainoutcome measures were independent predictors of treatment success after sacral nerve stimulation.
Results
From, all in all, 54 patients suffering from idiopathic fecal incontinence receiving peripheral nerve evaluation, favorableoutcome was achieved in 23 of 30 patients after sacral nerve stimulation (per protocol 76.7%; intention to treat 42.6%). From allanalyzed characteristics, wide anorectal angle at rest in preoperative defecography was the only independent predictor offavorable outcome in multivariate analysis (favorable 134.1 ± 13.9° versus unfavorable 118.6 ± 17.1°).
Conclusions
Anorectal angle at rest in preoperative defecography might present a predictor of outcome after sacral nervestimulation in patients with idiopathic fecal incontinence.