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Background: Neuro-modulation of the pelvic nerves is an effective and promising modality for treating fecal incontinence. Direct sacral nerve stimulation is the most popular for neuro-modulation although it is technically demanding. Percutaneous and transcutaneous posterior tibial nerve stimulations are relatively newer approaches for neuro-modulation and they carry the advantage of being cheaper and less invasive. There is not much published data about the transcutaneous approach and in this study, we are describing our experience with this technique. Objective: This study was conducted to describe and determine the efficacy of percutaneous posterior tibial nerve stimulation in the treatment of fecal incontinence. Design: A prospective descriptive study. Setting: The colorectal clinic in the hospital was prepared with the required equipment. The authors funded all procedures performed and the patients paid no extra charges. Patients and Methods: Our study included 15 patients with fecal incontinence visiting the colorectal clinic in Ain Shams University Hospital. All patients received 12 sessions of electric stimulation, 3 sessions per week for 40 minutes each. Main Outcome Measures: Sample Size Wexner score and the short term effect of the treatment. Sample Size: 15 patients. Results: The study included 11 females and 4 males, 2 patients were excluded from the results. The results showed that there was improvement in mean Wexner score for these patients from 13 before the treatment to 8 after finishing the treatment course. Reassessment after 6 months of treatment revealed no deterioration in their continence. Conclusion: We found that transcutaneous posterior tibial nerve stimulation is an effective, cheap, and tolerable method for treating fecal incontinence. However, long-term follow up is required on larger group of patients to adopt this technique. Limitations: Small sample size, short course follow up.Conflict of Interest: None.

Ileal pouch anal anastomosis is a commonly performed procedure. The operation can be completed in one stage, two stages, or three stages depending on the general condition of the patient and the local condition of the bowel. The J pouch is the most commonly performed pouch design. After construction, the pouch mesentery can be short, necessitating ligation and division of the superior mesenteric pedicel to allow the pouch reach the anal canal at ease. In this case, the ileocolic pedicle should be intact to give alternative blood supply to the newly constructed pouch. The ileocolic pedicle can be inadvertently injured during dissection to take down the ileostomy in the second stage of a three-stage operation. This can risk the pouch integrity in case the superior mesenteric pedicle needs to be divided. We are describing a method to avoid such inadvertent ileocolic vessel injury. After adopting this method, we did not have a single incident of ileocolic vessel injury in the second stage of a three-stage ileal pouch anal anastomosis.