# Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why — GCMD Library

This video from GlobalCast MD, featuring Cincinnati Children's, recaps key insights from the 13th Annual Pediatric Surgery Update Course on the use of Botox in Hirschsprung's Disease. It discusses current practices, poll results among pediatric surgeons regarding intrasphincteric botox injection during pull-through procedures, and findings from studies on its efficacy in reducing enterocolitis risk. Experts also delve into the challenges of dosing and the role of ultrasound guidance in these injections.

Type: video · 1 min · posted 2026-05-15
Canonical: https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049

## Chapters
- [0:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=1) Introduction and Topic Overview
- [0:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=28) Audience Poll Results
- [0:45](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=45) Evidence from Multi-Center and Cincinnati Studies
- [1:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=74) Technical Considerations and Practice Variation
- [1:35](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=95) Summary and Closing

## Statements
- "50% of polled surgeons would not inject Botox at the same time as pull-through procedure" — Lei Wen (epidemiological) [0:33](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=33)
- "The Cincinnati Children's group injects Botox at the same time of surgery" — Lei Wen (opinion) [0:42](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=42)
- "A 2022 multi-center study found that 24% of patients undergoing pull-through procedure also received Botox" — Jill Knepprath (epidemiological) [0:45](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=45)
- "Cincinnati Children's study from 2020 to 2024 found decreased risk of enterocolitis within 31 days after pull-through procedure: 0% versus 30%" — Lei Wen (clinical) [0:55](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=55)
- "Patients that received Botox had a higher chance of diaper rash" — Jill Knepprath (clinical) [1:09](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=69)
- "There is no evidence on the number of units of Botox to use" (clinical) [1:20](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=80)
- "Better data is needed on Botox dosing" (opinion) [1:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=83)
- "Ultrasound guidance allows visualization of every layer, needle position, injection amount and location, and diffusion pattern" (clinical) [1:25](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=85)
- "Injecting Botox during pull-through procedure for Hirschsprung's disease has been shown to reduce enterocolitis risk" — Jill Knepprath (clinical) [1:37](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=97)
- "Dosing and guidance for Botox injection varies widely" — Jill Knepprath (epidemiological) [1:41](https://library.globalcastmd.com/watch/update-course-rewind-2025-botox-for-hirschsprung-s-where-when-and-why-12049?t=101)

## Transcript
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.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai