Sacral Neuromodulation Improves Functional Outcome and Quality of Life in Patients with Pouch Dysfunction After Pan Proctocolectomy for Ulcerative Colitis
Bibliographic record
Abstract
Abstract Background Postoperative frequency of bowel movements and impaired fecal continence (FI) has a negative impact on quality of life following ileal pouch-anal anastomosis. Sacral neuromodulation (SNM) is a validated treatment of FI but its effectiveness in IPAA patients has been poorly reported. Aims The aim of this study was to evaluate the effectiveness of sacral neuromodulation (SNM) in improving the functional outcomes and quality of life of patients with pouch dysfunction following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. In particular, the study sought to compare the outcomes of SNM treatment in patients with IPAA suffering from fecal incontinence (FI) with those of patients routinely treated with SNM for FI. Methods A 3 weeks test-phase was performed before definitive implantation of the pulse generator. Patient’s data were prospectively gathered in a dedicated registry. IPAA patients were then compared to a matched-paired control group of patients routinely treated by SNM for FI. Results Between 2007 and 2020, 14 IPAA patients were tested and 12 (85%) were implanted. This group was compared to a matched group of 20 patients implanted for FI. After a mean follow-up of 4.8 [0.5-16] years, there was a significant decrease of weekly leaks (29 vs 2 ;p=0.01), Wexner score (15 vs 10.8 ;p=0.01) and an improvement of quality of life (FIQOL 1.853 vs 2.42 ;p=0.01). IPAA patients evolved equally as compared to the control group in terms of Wexner score and quality of life at 6 months, 1 year and 2 years. Conclusion SNM provides a significant decrease of leaks and improves Wexner scores and quality of life in IPAA patients. The effectiveness seems comparable to these of patients routinely treated by SNM for FI. SNM indications could be extended to IPAA patients presenting bad functional outcome.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".