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A prospective study of botulinum toxin for internal anal sphincter hypertonicity in children with Hirschsprung's disease.
J Pediatr Surg. 2000 Dec; 35(12):1733-6.JP

Abstract

BACKGROUND

Internal anal sphincter hypertonicity with nonrelaxation can cause persistent constipation and obstructive symptoms in children after surgery for Hirschsprung's disease. Intractable symptoms traditionally have been treated with anal myectomy, which may be ineffective or complicated by long-term incontinence. The authors evaluated prospectively the use of intrasphincteric botulinum toxin for these patients.

METHODS

Eighteen children were studied (age 1 to 13; median, 4 years). Botulinum toxin was injected (total dose 15 to 60 U) into 4 quadrants of the sphincter. Resting sphincter pressure was measured in 14 patients before and after injection. Ten have had 1 to 5 additional injections (total dose, 30 to 60 U per injection).

RESULTS

Four patients had no improvement in bowel function, 2 had improvement for less than 1 month, 7 had improvement for 1 to 6 months, and 5 had improvement more than 6 months. Nine of those with symptomatic improvement longer than 1 month had pressures measured, with a documented decrease in 8. Five with no significant clinical improvement had pressure measurements, with a decrease in 3. There were no adverse effects associated with botulinum toxin injection. Four children had new encopresis postinjection, which was mild and resolved in each case.

CONCLUSIONS

Intrasphincteric botulinum toxin is a safe and less-invasive alternative to myectomy for symptomatic internal sphincter hypertonicity. Persistent symptoms, despite a fall in sphincter pressure, suggest a nonsphincteric etiology. Repeat injections often are necessary for recurrent symptoms.

Authors+Show Affiliations

Division of Pediatric Surgery, Department of Surgery, St Louis Children's Hospital and Washington University School of Medicine, St Louis, MO, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11101725

Citation

Minkes, R K., and J C. Langer. "A Prospective Study of Botulinum Toxin for Internal Anal Sphincter Hypertonicity in Children With Hirschsprung's Disease." Journal of Pediatric Surgery, vol. 35, no. 12, 2000, pp. 1733-6.
Minkes RK, Langer JC. A prospective study of botulinum toxin for internal anal sphincter hypertonicity in children with Hirschsprung's disease. J Pediatr Surg. 2000;35(12):1733-6.
Minkes, R. K., & Langer, J. C. (2000). A prospective study of botulinum toxin for internal anal sphincter hypertonicity in children with Hirschsprung's disease. Journal of Pediatric Surgery, 35(12), 1733-6.
Minkes RK, Langer JC. A Prospective Study of Botulinum Toxin for Internal Anal Sphincter Hypertonicity in Children With Hirschsprung's Disease. J Pediatr Surg. 2000;35(12):1733-6. PubMed PMID: 11101725.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective study of botulinum toxin for internal anal sphincter hypertonicity in children with Hirschsprung's disease. AU - Minkes,R K, AU - Langer,J C, PY - 2000/12/2/pubmed PY - 2001/2/28/medline PY - 2000/12/2/entrez SP - 1733 EP - 6 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 35 IS - 12 N2 - BACKGROUND: Internal anal sphincter hypertonicity with nonrelaxation can cause persistent constipation and obstructive symptoms in children after surgery for Hirschsprung's disease. Intractable symptoms traditionally have been treated with anal myectomy, which may be ineffective or complicated by long-term incontinence. The authors evaluated prospectively the use of intrasphincteric botulinum toxin for these patients. METHODS: Eighteen children were studied (age 1 to 13; median, 4 years). Botulinum toxin was injected (total dose 15 to 60 U) into 4 quadrants of the sphincter. Resting sphincter pressure was measured in 14 patients before and after injection. Ten have had 1 to 5 additional injections (total dose, 30 to 60 U per injection). RESULTS: Four patients had no improvement in bowel function, 2 had improvement for less than 1 month, 7 had improvement for 1 to 6 months, and 5 had improvement more than 6 months. Nine of those with symptomatic improvement longer than 1 month had pressures measured, with a documented decrease in 8. Five with no significant clinical improvement had pressure measurements, with a decrease in 3. There were no adverse effects associated with botulinum toxin injection. Four children had new encopresis postinjection, which was mild and resolved in each case. CONCLUSIONS: Intrasphincteric botulinum toxin is a safe and less-invasive alternative to myectomy for symptomatic internal sphincter hypertonicity. Persistent symptoms, despite a fall in sphincter pressure, suggest a nonsphincteric etiology. Repeat injections often are necessary for recurrent symptoms. SN - 0022-3468 UR - https://www.unboundmedicine.com/medline/citation/11101725/A_prospective_study_of_botulinum_toxin_for_internal_anal_sphincter_hypertonicity_in_children_with_Hirschsprung's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(00)08429-3 DB - PRIME DP - Unbound Medicine ER -