269 Sacral Nerve Neuromodulation Therapy; a Promising New Treatment for Children with Refractory Functional Constipation

Background: Sacral nerve neuromodulation (SNM) therapy has been successfully applied in adult patients with urinary and fecal incontinence. Recently, SNM therapy showed good results in adults with refractory functional constipation. No data, however, are available of SNM therapy as a treatment option in children with refractory functional constipation. Aim: To describe the preliminary results of SNM therapy in children with chronic functional constipation refractory to intensive conservative treatment. Material and methods: Children with functional constipation according to the ROME III criteria not responding to intensive conservative treatment (laxatives, enemas and colonic lavage) were assigned for SNM therapy. When improvement of symptoms was seen during the percutaneous nerve evaluation (PNE) with a permanent electrode in the 3 weeks testing phase, a permanent sacral nerve neuromodulator was implanted. Patients were followed up for at least six months after implantation by interviews and bowel diaries. Improvement was defined as spontaneous defecation ≥ 3 times a week. Results: 5 patients (all females) 14 - 18 years old with functional constipation were included. None of them had spontaneous defecation at presentation. Duration of symptoms varied from 6 - 18 years and the duration of treatment from 1 -17 years. In all patients the testing phase was successful. After implantation of the permanent neuromodulator, all children had spontaneous defecation ≥ 3 times a week without medication. Conclusion: SNM is a promising new treatment option in children with refractory functional constipation not responding to intensive conservative therapy. However, larger prospective studies with long-term follow up are required.