Incobotulinum toxin A in pediatric coloproctology. First application experience in Russia

Abstract

In the last decade, botulinum toxin type A (BTA) has been used in children with colorectal diseases. There are no published papers on the topic in Russia. Objective. To investigate BTA effectiveness in children with different colorectal problems. Patients and methods. 9 patients from 1.7 to 14 years old (median age 3.5 years) were treated with the new method in the Speransky Children's Hospital (Moscow, Russia). The indications for treatment were various complaints (constipation, fecal pseudo-incontinence, painful defecation, obstructive defecation), anal hypertonia (spasm). We treated children in whom conservative therapy was ineffective. Incobotulinumtoxin A was administered under general anesthesia at a dose of 3–6 U/kg at 4 points along the circumference of the anal canal. Results. The effect of therapy was obtained in 7 out of 9 patients (77.8%). A good and excellent result was recorded in 4 patients (44.4%), mild – in 3 (33.3). There was no effect in two children with genetic pathology and Hirschsprung's disease with colostomy (22.2%). Conclusion. Circumferential chemodenervation with incobotulinumtoxin A of anal sphincters is an effective and safe method of treating children with defecation disorders resistant to routine conservative therapy, but further research is needed to develop patient selection, dose calculation and create guidelines injection technique and its frequency. Key words: dyssynergic defecation, painful defecation, hirschsprung, achalasia, incobotulinumtoxin A, children