A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

Velde SV, Biervliet SV, Bruyne RD, Winckel MV. (2013). A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients.

Spinal Cord. 2013 Oct 15. doi: 10.1038/sc.2013.123. [Epub ahead of print]

Abstract

Study design:Systematic review.Objectives:To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness.Setting:International literature.Method:Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion.Results:Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n=509). In patients using RCE (n=190) an 80% continence rate was reached. Patients following surgical treatment (n=469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management.Conclusion:Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.Spinal Cord advance online publication, 15 October 2013; doi:10.1038/sc.2013.123.

 

PMID:24126852