Medical first in Croatia as sacral nerve stimulation surgery successfully performed

(Photo credit: KBC Rijeka)

The procedure for the implantation of a sacral nerve stimulator (SNS) for fecal incontinence was successfully performed for the first time in Croatia and the broader region at the Department of Digestive Surgery at the Clinical Hospital Center in Rijeka yesterday.

This marks the beginning of another segment of surgical treatment for functional disorders of the digestive system, specifically incontinence. Incontinence refers to the inability to adequately evacuate stool, resulting in involuntary bowel movements often associated with urinary incontinence due to damage to the pelvic floor muscles. 

These conditions significantly disrupt the quality of life for patients, who become reliant on various aids that necessitate frequent medical interventions.

Electrostimulation, or sacral nerve stimulation, is indicated for a specific group of patients for whom conservative methods of treating fecal incontinence have been unsuccessful. The need for such treatment is determined by a multidisciplinary team of experts, including gastroenterologists, digestive surgeons, radiologists, and stoma therapists.

The procedure for the implantation of the sacral nerve stimulator consists of two phases. In the first phase, patients undergo a trial phase where an electrode is implanted, connected to an external stimulator (the actual implantation of the neurostimulator is not immediate), to determine if there will be an improvement for the patient. In the second phase, if the patient experiences the aforementioned improvement, a permanent neurostimulator is implanted subcutaneously in the gluteal region, KBC Rijeka said in a statement.

“This procedure has been incorporated into the guidelines of many international professional societies dealing with the problems of colon diseases, as one of the treatment options for a specific group of patients that offers a significant chance of returning to normal life. Previous studies have found that SNS implantation is highly cost-effective in treating the mentioned health disorders. In these patients, the number of doctor visits, radiological examinations, emergency room visits, hospitalizations, and surgical procedures is reduced, which can lead to annual savings and a significant reduction in healthcare costs,” emphasized Assoc. Prof. Dr. Marko Zelić, Head of the Department of Digestive Surgery.

SNS procedures have been performed for years in the world’s leading healthcare centers for treating urinary and fecal incontinence, placing the performance of this type of procedure in the Rijeka hospital among advanced medical institutions.

“The Department of Digestive Surgery at the Surgery Clinic of the Rijeka Clinical Hospital Center is one of the few centers in the broader geographical area that actively addresses the treatment of functional disorders. As the Department holds the status of the Ministry of Health’s Reference Center for minimally invasive surgery of the colon, rectum, and anorectal region, the introduction of a new procedure is a logical progression in the development of a highly specialized center of excellence,” emphasized Prof. Dr. Alen Ružić, Director of the Rijeka Clinical Hospital Center.

On Thursday, October 19, in the departments of digestive surgery at the Rijeka hospital, two gastric pacemakers were implanted in one day, as well as three sacral modulation neurostimulators for the first time, completing the outlined procedures for surgical treatment of functional gastrointestinal diseases. The procedures were performed by a team from the Department led by Head Professor Marko Zelić and physicians Damir Karlović and Dorijan Kršul. The surgical team was supported by anesthesiologist Danijel Knežević and surgical instrument specialists Predrag Vlahović and Davorin Brajdić, along with numerous other medical colleagues, nurses, and technicians involved in the screening and preparation of these patients.

The innovative intervention also involved Prof. Dr. Stefan Riss from the University Hospital in Vienna, where the Rijeka digestive surgeons were educated on the newly introduced method of treating severe diseases.

In 2016, the Rijeka Clinical Hospital Center also performed, for the first time in the Central and Southeastern Europe region, surgical procedures for the implantation of a system for gastric electrostimulation to treat the chronic condition of gastric paralysis resulting from severe and complicated diabetes. To date, 25 patients have undergone the implantation of electrostimulative devices, resulting in a significant improvement in their quality of life and the treatment of diabetes itself as the primary disease. 

Stefan Riss, Marko Zelić, Damir Karlović, Dorijan Kršul (Photo credit: KBC Rijeka)

Specifically, such patients were unable to adequately consume food, and as they were dependent on insulin therapy, this frequently led to complications in the form of frequent hypoglycemia, a serious condition associated with low blood sugar levels.

The Department of Digestive Surgery has thus gained pioneering experience in the therapeutic area of neuromodulation of the digestive system, and the newly established method represents a continuation of the initially introduced therapy.