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308 Chapter 15 Twelve of 16 parents (75%) of patients with functional constipation provided information on patient benefit and parent satisfaction. The median GCBI score for patients with functional constipation was +39.58. Eleven of 12 parents (92%) reported that they would proceed with SNS if given the chance to remake their decision. Presence of concurrent fecal incontinence Eighteen of our 25 patients (72%) had constipation with concurrent fecal incontinence and seven patients (28%) had constipation alone. We did not find significant differences in ability to discontinue laxative or ACE use after SNS treatment between patients with and without concurrent fecal incontinence. We also did not find any differences between the GCBI scores or satisfaction questionnaire responses of the two groups. Interestingly, patients without concurrent fecal incontinence required further surgery after SNS more often (4/7, 57%) than patients with concurrent fecal incontinence (3/18, 17%; P = .04). DISCUSSION Our study suggests that SNS can be an effective, long-term treatment option for children with refractory constipation. We found that SNS led to continued improvement in both symptoms and quality of life at 2 years after treatment initiation, with particular improvement in concurrent fecal incontinence. At follow-up, 68% of our patients fulfilled our criteria for successful response and 24% fulfilled criteria without concurrent laxative or ACE use. Although a quarter of patients developed a complication requiring additional surgery, nearly all parents reported health-related benefit from the treatment and all parents would recommend SNS treatment to other families with children experiencing similar symptoms. Although long-term outcomes of SNS treatment for adults with defecation disorders have been reported, information on long-term outcomes for children with defecation disorders remains limited. In the first study of SNS treatment for children with constipation, van Wunnik et al. described symptomatic improvement in 12 adolescent females with functional constipation at up to 12 months of follow-up. 9 Sulkowski et al. reported short- term outcomes of the first 29 children treated with SNS at our institution, which included 22 children who had constipation at baseline. This group, which included both children with organic causes of constipation and functional constipation, experienced significant improvement both symptomatically and in quality of life at a median of 4-5 months after SNS initiation. 10 A portion of this group was included in the current study. Van der Wilt et al. recently published a follow-up study that included the group originally described by van Wunnik, and they reported significant symptomatic improvement in 27 female children and adolescents who had been treated with SNS for 12-37 months. The authors concluded that