Results of the use of botulinum toxin (Botox) in the treatment of obstructive colopathy after surgical treatment of patients with Hirschsprung's disease

BACKGROUND: The article presents the experience of treating patients who underwent surgery for Hirschsprung's disease and suffer from obstructive colopathy caused by achalasia of the internal anal sphincter. AIM: Rationale for the treatment tactics of obstructive colopathy caused by hypertonicity of the internal anal sphincter after "pull-through" surgery for Hirschsprung's disease, using botulinum toxin injections. METHODS: The study included 15 patients, 9 of them boys, with an average age of 4 years at the time of the procedure. In 80% of cases (12 patients), the botulinum toxin injection procedure was performed more than once (2 children ― three times) with an interval of 6 months. The main complaints were constipation in all cases, colostomy in 60% of cases, bloating and flatulence in 80%, recurrent Hirschsprung-associated enterocolitis in 80%. The average maximum size of the colon according to irrigography was 80 mm. RESULTS: The analysis showed that the dynamics after botulinum toxin administration showed statistically significant changes in the occurrence of constipation (p 0.001) and fecal incontinence (p = 0.006) and the frequency of Hirschsprung-associated enterocolitis (p = 0.001). During the analysis of pressure changes in the anal canal before and after administration of Botox, statistically significant changes in pressure values were observed at rest, with voluntary contraction and with coughing (p 0.001). CONCLUSION: The study shows that the administration of botulinum toxin in anal sphincter achalasia in patients undergoing Hirschsprung's disease surgery significantly facilitates the manifestations of obstructive colopathy.

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