14781-koppen

309 Outcomes of sacral nerve stimulation 15 although response to SNS was heterogeneous in their cohort, SNS does appear to provide sustained benefit for children with functional constipation refractory to conventional treatment. 11 Our findings add to the evidence that SNS can be an effective and durable treatment option for children with refractory constipation. Although our study included both patients with organic causes of constipation and functional constipation, subgroup analysis of patients with functional constipation demonstrated clinical improvement and patient benefit that was similar to that of our entire cohort. However, it is important to recognize that although SNS has become an established treatment option for adults with refractory fecal incontinence, evidence for its use for adults with constipation is less clear. 6 In fact, two recent randomized crossover studies did not find SNS to be more effective than sham stimulation for adults with refractory constipation. 7,8 In children, fecal incontinence often occurs secondary to poorly controlled constipation and is commonly used as a primary outcome to define treatment success in studies of pediatric constipation. 19,20 The majority of the patients in our study suffered from concurrent fecal incontinence prior to initiation of SNS, and we did find a significant decrease in the number of children suffering from fecal incontinence after SNS treatment. This improvement was also reflected by corresponding changes in FIQL and FISI scores. Therefore, the question arises whether the clinical improvement demonstrated in our study was the result of improvement in fecal incontinence alone rather than in the child's underlying constipation. Although our analysis is limited by our sample size, our comparison of outcomes between patients with and without concurrent fecal incontinence suggests that SNS can be beneficial for children with constipation regardless of the presence of fecal incontinence. However, particularly given recent findings in the adult literature, this is a question that needs to be evaluated further as we continue to search for predictors of response to SNS treatment. Families generally viewed SNS treatment as beneficial to their children. The median GCBI score of our sample was +42.7, which suggests a strongly positive perceived benefit after SNS treatment initiation. This score was higher than the reported GCBI of a number of established surgical procedures, including tonsillectomy and adenoidectomy (+21), otoplasty (+24.4), and septoplasty (+35.1). 21–23 Comparable measures of patient benefit are not available for other treatment options for pediatric intractable constipation, such as ACE or colonic resection. As part of our assessment of parent satisfaction, we asked parents to explain their answers to our satisfaction questionnaire without further prompting. A theme we noticed in their responses was that SNS allowed their children to live a more “normal” life when compared