Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why

Globalcast MD along with Cincinnati Children's Hospital sharing knowledge to improve child health around the globe. I'm Jill Knepprath with Stay Current MD. In this video series, we will be recapping some of the key highlights from our 13th annual update course in pediatric surgery. This is on Botox for Hirschprung's disease. Where, when, and why. Doctor Lei Wen poses this question to the audience. During a pull-through procedure for patients with Hirschsprung's disease, do you inject Botox? From the poll, 50% would not inject the Botox at the same time of the pull-through. And then the rest is either yes or variable. We as a group would inject Botox at the same time of the surgery. A 2022 multi-center study found that 24% of patients who were undergoing a pull-through procedure also received Botox. We did a study at Cincinnati Children's from 2020 to 2024, and what we found is that within the 31st days after the pull-through procedure, there's a decreased risk of enterocolitis. 0% versus 30%. The patients that received Botox did have a higher chance of diaper rash. How many units are you using, the injections frequency, do you use ultrasound guidance to do your injections? The number of units is challenging because there's no evidence on it. We need a little bit better data on this. I definitely use an ultrasound, but that's just my practice. I can see every layer where the needle is, how much I put where, and where it diffuses to, but you have to be comfortable using the ultrasound. Let's summarize. Injecting Botox during a pull-through procedure for Hirschsprung's disease can be done. It's been shown to reduce enterocolitis risk, but dosing and guidance varies widely. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.