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Minerva Pediatrica 2018 Nov 07

DOI: 10.23736/S0026-4946.18.05238-6


lingua: Inglese

Intrasphincteric BoTox injections in Hirschsprung’s disease: indications and outcome in 64 procedures over a ten-year period

Alessio PINI PRATO 1 , Maria Grazia FATICATO 2, 3, Cinzia MAZZOLA 2, Serena ARRIGO 4, Girolamo MATTIOLI 2, 3, Rossella ARNOLDI 1, Manuela MOSCONI 2

1 Pediatric Surgery Unit, The Children Hospital, AON S.S. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; 2 Department of Pediatric Surgery, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy; 3 Department of Neuroscience, Ophthalmology, Rehabilitation, Genetics and Maternal-Infant Science (DINOGMI), University of Genoa, Genoa, Italy; 4 Pediatric Gastroenterology Unit, Giannina Gaslini Children's Hospital, Institute for
Scientific Research, Genoa, Italy


BACKGROUND: Intrasphincteric Botulinum toxin (BoTox) injection for symptomatic postoperative anal achalasia in Hirschsprung's disease (HSCR) has found wide application in the last twenty years. The aim of this study is to describe effectiveness and functional outcome of a series of patients treated over a 10-year period.
METHODS: All consecutive HSCR patients who received intrasphincteric BoTox injections between January 2007 and December 2016 were included. Demographic data and clinical features were collected. A detailed questionnaire focusing on outcome in the medium and long term was administered to all families.
RESULTS: In the study period 64 intrasphincteric BoTox injections were performed in 31 patients. Completed questionnaires were returned by 27 out of 28 eligible patients (96%) reporting improvement or symptoms resolution in 16 (59%). The highest success rates were experienced by patients younger than 4, with long HSCR forms and with recurrent enterocolitis (75%, 100% and 100% of success rates, respectively). No major complications occurred. Minor complications were described by 7 patients (26%).
CONCLUSIONS: Intrasphincteric BoTox injection proved to be feasible, safe and reasonably effective in children with HSCR and postoperative anal achalasia. Infants and toddlers with long HSCR forms and recurrent bouts of enterocolitis are those who would benefit most from this treatment.

KEY WORDS: BoTox - Achalasia - Hirschsprung - Enterocolitis - Constipation

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