Mahmoud ElFiky

Background: Neurotoxic protein produced by Clostridium botulinum has many therapeutic indications with few studies on its role in constipation. Treatment of intractable constipation surgically has been Internal Sphincter Myectomy.

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 5 cm. 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) & 6.34 (B). Male to Female ratio 2.3:1. Mean duration of illness 2.95 years (A) & 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) & 70% (B) on follow up to 6 months. Most cases achieved 1-3 motions per day 70% (A) & 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.