PhD Defence Stella C.M. Heemskerk

Keywords: Sacral neuromodulation; slow-transit constipation; outcome heterogeneity; (cost-)effectiveness
 

"Sacral neuromodulation for idiopathic slow-transit constipation"
 

Patients with slow-transit constipation have bowel movements less than 3 times per week, experience severe constipation symptoms, and have a reduced quality of life. For patients who do not respond sufficiently to usual treatment (such as medication or bowel irrigation), sacral neuromodulation (SNM) may offer a solution. SNM is a minimally invasive surgical treatment that stimulates the nerves controlling the bowel. This thesis examined the effectiveness and costs of SNM compared to usual treatment for patients with slow-transit constipation. In a comparative study, patients were followed for 6 months. After 6 months, there was a 49,9% difference in treatment success, favoring SNM. Additionally, SNM patients had less severe constipation, less fatigue, and an improved quality of life. However, SNM was more expensive, with an cost-difference of €14,000. Lastly, this thesis showed a high variation in the types of outcomes and measurement tools used in research on slow-transit constipation and SNM, making it difficult to compare study results. As a result, there is currently no clear evidence on the effectiveness and costs of SNM for slow-transit constipation.

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