Routine botulinum toxin injection one month after a Swenson pull-through does not change the incidence of Hirschsprung associated enterocolitis

Purpose: Patients with Hirschsprung disease (HD) are at risk of Hirschsprung associated enterocolitis (HAEC) following pull-through. The purpose of this study was to determine if routine Botulinum toxin (BT) injected one-month post pull-through decreases the incidence of HAEC. Methods: We reviewed patients who underwent a primary (not redo) pull-through operation for HD be-tween April 2014 to December 2019. Over the most recent 18 months, BT was administered routinely one-month post-pull-through procedure; these patients were compared to the prior group that did not receive routine BT. A HAEC episode was defined as one that required initiation of treatment for obstruc-tive symptoms in the inpatient or outpatient setting with antibiotics and irrigations. Categorical variables were compared using the nonparametric chi-square test or Fisher's exact test. Continuous variables were compared using the two-tailed Student's t-test. P-value < 0.05 was determined to be statistically signifi-cant. Results: A total of 70 patients underwent Swenson pull-through during the study period (52% male). There were no statistically significant differences in demographics in the BT vs. non-BT group. Routine post-pull-through BT was given in 28 patients and did not significantly change HAEC incidence compared to the non-BT group (12/28, 43% vs. 16/42, 38%. P = 0.691). Of note, the BT group patients developed HAEC significantly sooner than the patients in the non-BT group (37.5 days vs. 253 days, p = 0.029). More patients in the BT group ( n = 18, 64%) required at least one subsequent BT injection compared to the patients in the non-BT group ( n = 11, 26%. P = 0.001). Conclusions: We conclude that routine postoperative botulinum toxin injection given one month post-operatively from Swenson pull-through did not change the incidence of HAEC. A prospective controlled study is necessary to confirm these findings. (C) 2021 Elsevier Inc. All rights reserved.