Comparative Study between Botulinum Toxin Injection and Internal Anal Sphincter Myectomy for Treatment of Chronic Idiopathic Constipation, MAHMOUD M.A. EL-FIKY, MOHAMED EL-BARBARY, SHERIF KADDAH, MOSTAFA A. GAD and GAMAL H. EL-TAGY
Abstract
Background: Treatment of intractable constipation surgi-cally has been Internal Sphincter Myectomy. Neurotoxic protein produced by Clostridium botulinum has many thera-peutic indications with few studies on its role in constipation.
Aim of the Study: Comparative study between internal sphincter myectomy and Botulinum toxin (BOTOX ®) injec-tion of the internal anal sphincter as a treatment for idiopathic constipation in children.
Methods: Cases were selected with positive Rome III criteria for Chronic Idiopathic Constipation that failed medical treatment for at least 6 months. Cases with suspected other causes of constipation were excluded. Randomization was performed and data collected using REDCap. All cases received colonic preparation. Half the cases (Group A) underwent Internal Sphincter Myectomy at least 5cm. The other half (Group B) received intrasphincteric injection of Botulinum toxin type A.
Results: Twenty cases were selected. Mean age was 4.4 years (A) Er 634 (B). Male to female ratio 23:1. Mean duration of illness 2.95 years (A) b 4.15 (B). No major complication in both groups. Soiling improved in both groups (p=0.051). Constipation relief based on Zero Rome III criteria was obtained in 80% (A) Er 70% (B) on follow-up to 6 months. Most cases achieved 1-3 motions per day 70% (A) Er 50% (B).
Conclusion: Botulinum toxin injection is equally effective but less invasive than Myectomy. Larger sample and longer follow-up are needed to full evaluate results.