Botulinum toxin, a new treatment modality for chronic idiopathic constipation in children: long-term follow-up of a double-blind randomized trial.
BACKGROUND
Myectomy of the internal anal sphincter (IAS) has been performed on some children after failure of medical treatment to treat idiopathic constipation. The aim of this study was to compare botulinum toxin injection with myectomy of the IAS in the treatment of chronic idiopathic constipation and soiling in children.


METHODS
This was a double-blind randomized trial. Patients between 4 and 16 years old were included in the study if they had failed to respond to laxative treatment and anal dilatation for chronic idiopathic constipation. All study patients had anorectal manometry and anal endosonography under ketamine anesthesia. Outcome was measured using a validated symptom severity (SS) scoring system, with scores ranging from 0 to 65.


RESULTS
Of 42 children, 21 were randomized to the botulinum group and 21 were randomized to the myectomy group. At the 3-month follow-up, the median preoperative SS score improved from 34 (range = 19-47) to 20 (range = 2-43) in the botulinum group (P < .001) and from 31 (range = 18-49) to 19 (range = 3-47) in the myectomy group (P < .002). At the 12-month follow-up, the scores were 19 (range = 0-45) and 14.5 (range = 0-41) for the botulinum group and the myectomy group, respectively (P < .0001). There was no complication in both groups.


CONCLUSIONS
Botulinum toxin is equally effective as and less invasive than myectomy of the IAS for chronic idiopathic constipation and fecal incontinence in children.
Keshtgar
Alireza S
AS
Department of Pediatric Surgery, Guy's and St Thomas' Hospital, National Health Service Foundation Trust, SE1 9RT London, United Kingdom. ali.keshtgar@uhl.nhs.uk
Ward
Harry C
HC
Sanei
Ahmad
A
Clayden
Graham S
GS
D000293:Adolescent; D001003:Anal Canal / Q000601:surgery; D001905:Botulinum Toxins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy* / Q000601:surgery; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D009465:Neuromuscular Agents / Q000008:administration & dosage*
D009465:Neuromuscular Agents; D001905:Botulinum Toxins