Meta-analysis of Randomized Controlled Trials on the Efficacy of Sacral Neuromodulation in Chronic Constipation

Objectives

The present systematic review aimed to assess the outcome of sacral neuromodulation (SNM) in adult patients with chronic constipation.

Materials and Methods

A systematic review of randomized controlled trials (RCTs) that assessed the efficacy of SNM in chronic constipation was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline. PubMed, Scopus, and Web of Science were screened from their inception through March 2024. The primary outcome was improvement in constipation and quality of life (QoL), and the secondary outcome was adverse events after treatment. The risk of bias and certainty of evidence were assessed by the risk of bias 2 tool and Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

Five RCTs incorporating 187 patients (93.6% female) with a median age of 42.5 years were included; 154 patients underwent SNM whereas 86 patients were crossed over to sham stimulation, and 33 received conservative treatment, amounting to a control group of 119 patients. The odds of relief of constipation after SNM were similar to those in the control group in the random-effect model (odds ratio [OR]: 1.92, 95% CI: 0.68–5.42, p = 0.217). The median percentage of reduction in the Cleveland Clinic Florida/Wexner Constipation Score was 27.9% in the SNM group vs 18.4% in the control group. No significant differences were observed in QoL. Both groups had similar odds of adverse events (OR: 2.22, 95% CI: 0.19–25.53, p = 0.521).

Conclusion

Although a relatively safe treatment, SNM was not associated with any tangible improvements in either constipation or QoL.