Histology and function of the internal anal sphincter after injection of botulinum toxin

The Journal of Surgical Research
J C LangerR E Schmidt

Abstract

Children with Hirschsprung's disease may have persistent obstructive symptoms due to internal anal sphincter hypertonicity, even after definitive surgery. Anal myectomy is not universally effective and may result in permanent sphincter injury. Botulinum toxin injection has been used to selectively weaken a variety of muscles and could theoretically represent a less invasive option for children with this difficult problem. We evaluated the efficacy and safety of botulinum toxin in an immature porcine model. Six-week-old piglets underwent four-quadrant intrasphincteric injection of botulinum toxin or saline. Under ketamine sedation, internal sphincter resting pressure was measured using a water-perfused system before injection and 4 weeks later. Animals were sacrificed 4 weeks after injection. Histological evidence of neuromuscular changes or inflammation in the internal sphincter was documented. All analysis was done blindly. Internal anal sphincter pressure increased in control animals, likely due to growth over the 4-week period. Conversely, botulinum toxin injection was associated with a significant decrease in internal sphincter pressure. There were no significant differences between the botulinum toxin and control groups wi...Continue Reading

References

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Dec 1, 1995·The Journal of Pediatrics·A G Catto-SmithJ M Hutson
May 1, 1996·Gastroenterology·P J PasrichaA N Kalloo

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Citations

Apr 1, 2008·Journal of Indian Association of Pediatric Surgeons·S M V HosseiniB Sabet
Jan 22, 2005·Seminars in Pediatric Surgery·Alireza S KeshtgarGraham S Clayden
Jun 4, 2015·Muscle & Nerve·Zi-Jun LiuSusan W Herring
Jan 27, 2015·Pediatric Surgery International·Tomas Wester, Anna Löf Granström
Aug 5, 2000·The American Journal of Gastroenterology·C Di LorenzoP E Hyman
Jun 16, 2017·Pediatric Surgery International·Yew-Wei TanJoe Curry

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