Обмін досвідом/ Exchange of experience

Botulinum toxin use in paediatric colorectal surgery/ Застосування Ботулотоксину у дитячій колоректальній хірургії

Basson, S., Charlesworth, P., Healy, C. et al. Pediatr Surg Int (2014) 30: 833. https://doi.org/10.1007/s00383-014-3536-4

Abstract

Purpose

To evaluate outcomes of intrasphincteric botulinum toxin injection (ISBTI) in children with intractable constipation.

Methods

Retrospective case-note review of patients ≤16 years of age undergoing ISBTI between January 2010 and February 2014. Data collected included patient demographics, diagnosis, complications, follow-up duration and functional outcomes. Successful outcome was defined as resolution/improvement in symptoms and failed when there was no change in symptoms. Statistical analyses were performed using PRISM (GraphPad, CA, USA). p values <0.05 were considered as significant.

Results

43 patients [male 29, median age 5 years 9 months (range 13 months–13 years 5 months)] underwent 86 ISBTIs. Underlying diagnoses were idiopathic constipation (67 %), Hirschsprung disease (26 %), anorectal malformation (5 %), gastrointestinal dysmotility (2 %). 72 % (31/43) reported improvement in symptoms after the first ISBTI. 39 % of patients had recurrence of symptoms at 12-month median follow-up. 10 patients non-responsive to ISBTI required an antegrade continence enema or stoma. There was no correlation between age (p = 0.3), gender (p = 0.7), diagnosis  (p  = 0.84), or number of ISBTIs (p = 0.17) with successful outcome.

Conclusion

Successful outcomes occurred in 72 % patients after the first ISBTI. 25 % required further surgical management of their symptoms. Further work is required to help predict which patients will benefit from ISBTI.

Keywords

Botulinum toxin Idiopathic constipation Hirschsprung Anorectal malformation Anal sphincter 

Notes

Acknowledgments

The authors would like to thank Mr. Harry Ward and Continence Nurse Specialists Susan McDowel, Sally Broadhead and Claire Foster, for their contribution to the care and management of these patients.

Conflict of interest

The authors declare that they have no conflict of interest.

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