{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:34:59Z","timestamp":1792031699137,"version":"4.4.0"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,21]],"date-time":"2024-01-21T00:00:00Z","timestamp":1705795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Sacral neuromodulation (SNM) is a minimally invasive treatment option for functional constipation. Evidence regarding its effectiveness is contradictory, driven by heterogeneous study populations and designs. The aim of this study was to assess the effectiveness, safety and cost\u2010effectiveness of SNM in children and adults with refractory idiopathic slow\u2010transit constipation (STC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>OVID Medline, OVID Embase, Cochrane Library, the KSR Evidence Database, the NHS Economic Evaluation Database and the International HTA Database were searched up to 25 May 2023. For effectiveness outcomes, randomized controlled trials (RCTs) were selected. For safety outcomes, all study designs were selected. For cost\u2010effectiveness outcomes, trial\u2010 and model\u2010based economic evaluations were selected for review. Study selection, risk of bias and quality assessment, and data extraction were independently performed by two reviewers. For the intervention \u2018sacral neuromodulation\u2019 effectiveness outcomes included defaecation frequency and constipation severity. Safety and cost\u2010effectiveness outcomes were, respectively, adverse events and incremental cost\u2010effectiveness ratios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1390 records reviewed, 67 studies were selected for full\u2010text screening. For effectiveness, one cross\u2010over and one parallel\u2010group RCT was included, showing contradictory results. Eleven studies on safety were included (four RCTs, three prospective cohort studies and four retrospective cohort studies). Overall infection rates varied between 0% and 22%, whereas reoperation rates varied between 0% and 29%. One trial\u2010based economic evaluation was included, which concluded that SNM was not cost\u2010effective compared with personalized conservative treatment at a time horizon of 6\u2009months. The review findings are limited by the small number of available studies and the heterogeneity in terms of study populations, definitions of refractory idiopathic STC and study designs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Evidence for the (cost\u2010)effectiveness of SNM in children and adults with refractory idiopathic STC is inconclusive. Reoperation rates of up to 29% were reported.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16876","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T07:24:56Z","timestamp":1705908296000},"page":"417-427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Effectiveness, safety and cost\u2010effectiveness of sacral neuromodulation for idiopathic slow\u2010transit constipation: a systematic review"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1320-8084","authenticated-orcid":false,"given":"Stella C. 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