Comparison of Botox Injection and Myomectomy for the Treatment of Resistant Functional Constipation in Children

Document Type : Original Article(s)

Authors

1 Associated Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Pediatric Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jims.v43.i832.1182

Abstract

Background: Botox injection and myomectomy are two treatment options offered for treatment-resistan functional constipation; however, their comparative effectiveness remains controversial. Therefore, this study aimed to compare the outcomes of botox* injection and myomectomy in children with functional constipation.
Methods: In this clinical trial study, 64 pediatric patients with functional constipation were divided into two groups of 32. The first group underwent myomectomy and the second group received Botox injection. Treatment outcomes were assessed and compared between the two groups one year after intervention using a Rome III–based constipation scoring system.
Findings: In the Botox group, the mean constipation score based on a Rome III–based scoring system increased from 13.67 ± 5.24 before treatment to 36.80 ± 7.31 after treatment, showing a significant difference (P < 0.001). In the myomectomy group, the mean constipation score increased from 12.43 ± 4.72 to 36.18 ± 6.48 after treatment (P < 0.001). There was no significant difference in the mean post-treatment constipation scores between the botox and myomectomy groups (P = 0.74).
Conclusion: The results of this study suggest that both Botox injection and myomectomy are effective in the treatment of functional constipation. However, considering the less invasive nature and fewer post-treatment complications associated with Botox injection, this approach may be preferable in selected patients.

Highlights

Mehrdad Hosseinpour: Google Scholar, PubMed

Masoud Nazem: Google Scholar, PubMed

Asadollah Roushani: Google Scholar, PubMed 

Keywords

Main Subjects

References

  1. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58(2): 258–74.
  2. Borowitz SM, Cox DJ, Kovatchev B, Ritterband LM, Sheen J, Sutphen J. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics 2005; 115(4): 873–7.
  3. Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: A systematic review. Best Pract Res Clin Gastroenterol 2011; 25(1): 3–18.
  4. Mill M, Koppen IJ, Benninga MA. Controversies in the Management of Functional Constipation in Children. Curr Gastroenterol Rep. 2019; 21(6): 23.
  5. Bongers MEJ, van Wijk MP, Reitsma JB, Benninga MA. Long-termprognosis for childhood constipation: Clinical outcomes in adulthood. Pediatrics 2010; 126(1): e156–62.
  6. Seon Choung R, Shah ND, Chitkara D, Branda ME, van Tilburg MA, Whitehead WE, et al. Direct medical costs of constipation from childhood to early adulthood: A population-based birth cohort study. J Pediatr Gastroenterol Nutr 2011; 52(1): 47–54.
  7. Liem O, Harman J, Benninga M, Kelleher K, Mousa H, Di Lorenzo C. Health utilization and cost impact of childhood constipation in the United States. J Pediatr 2009; 154(2): 258–62.
  8. Belsey J, Greenfield S, Candy D, Geraint M. Systematic review: Impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther 2010; 31(9): 938–49.
  9. Siminas S, Losty PD. Current Surgical Management of Pediatric Idiopathic Constipation: A systematic review of published studies. Ann Surg 2015; 262(6): 925–33.
  10. Zar-Kessler C, Kuo B, Belkind-Gerson J. Botulinum toxin injection for childhood constipation is safe and can be effective regardless of anal sphincter dynamics. J Pediatr Surg 2018; 53(4): 693–697.
  11. Keshtgar AS, Ward HC, Clayden GS. Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure. J Pediatr Surg 2009; 44(9): 1791–8.
  12. Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol 2020;14(1): 39-46.
  13. Hashish M, Elsawaf M. Short-term outcome of posterior anorectal myectomy for treatment of children with intractable idiopathic constipation. Annals of Pediatric Surgery 2017; 13(1): 26–8.
  14. Redkar RG, Mishra PK, Thampi C, Mishra S. Role of rectal myomectomy in refractory chronic constipation. Afr J Paediatr Surg 2012; 9(3): 202-5.
  15. Halleran DR, LuP L, Ahmad H, Paradiso MM, Lehmkuhl M, Akers A, et al. Anal sphincter botulinum toxin injection in children with functional anorectal and colonic disorders: A large institutional study and review of the literature focusing on complications. J Pediatr Surg 2019; 54(11): 2305-10.

 

Journal of Isfahan Medical School
Volume 43, Issue 832
4th Week, November
November and December 2025
Pages 1182-1188

Files

History

  • Receive Date: 17 May 2024
  • Accept Date: 05 October 2025

Share

How to cite

Statistics