title: Botulinum toxin use in paediatric colorectal surgery.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatric Surgery, The Royal London Hospital, Whitechapel, London, E1 1BB, UK.
authors.forename: S
authors.initials: S
authors.lastname: Basson
authors.forename: P
authors.initials: P
authors.lastname: Charlesworth
authors.forename: C
authors.initials: C
authors.lastname: Healy
authors.forename: S
authors.initials: S
authors.lastname: Phelps
authors.forename: Stewart
authors.initials: S
authors.lastname: Cleeve
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003107:Colorectal Surgery; D003248:Constipation / Q000628:therapy*; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006627:Hirschsprung Disease / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A