Article

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.

Langue : ANGLAIS