{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:17:29Z","timestamp":1787588249899,"version":"build-2736575974"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"Jadefonds"},{"name":"Prins Bernhard Cultuurfonds"},{"DOI":"10.13039\/501100006509","name":"VSB Fonds","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006509","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Anal sphincter botulinum toxin injections (BTIs) are used in the treatment of children with severe defecation disorders, including Hirschsprung disease (HD) and functional constipation (FC). Our objective was to evaluate the outcomes of BTI in these children.<\/jats:p><jats:p>\n          Materials and Methods\u2003We performed a prospective cohort study of children undergoing BTI from July 2018 to December 2018. We recorded perceived effect of the BTI, including effectiveness ranging from 0 (not at all effective) to 4 (extremely effective). In addition, we recorded symptoms and the Cleveland Clinic Constipation Score (CCCS). Data were collected at baseline and at 2 weeks, 2 months, and 4 months post-injection.<\/jats:p><jats:p>\n          Results\u2003Forty-two children (HD\u2009=\u200925, FC\u2009=\u200917) were included in the study (median age 4.3 years, IQR 2.4\u20137.2, 52% male). Twenty-two (88%) children with HD and eight (47%) children with FC had previously undergone a BTI. BTIs were perceived effective in 16 (76%) and 12 (71%) children with HD and eight (47%) and seven (47%) children with FC at 2-week and 2-month follow-up, respectively. Effectiveness was not rated differently between groups except at the 2-month follow-up, when patients with HD rated the BTI more effective compared to those with FC (median 2 [HD] vs. median 1 [FC], p\u2009=\u20090.022). Over the course of the study, 17\/39 (44%) children reported self-limiting adverse effects such as fecal incontinence and pain at the injection site.<\/jats:p><jats:p>\n          Conclusion\u2003Anal sphincter BTIs can be effective in the treatment of constipation in both HD and FC patients.<\/jats:p>","DOI":"10.1055\/s-0042-1751048","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T22:49:21Z","timestamp":1658270961000},"page":"241-248","source":"Crossref","is-referenced-by-count":15,"title":["Anal Botulinum Toxin in Children with Hirschsprung Disease and Functional Constipation: A Prospective Cohort study"],"prefix":"10.1055","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0163-9354","authenticated-orcid":false,"given":"Desiree F.","family":"Baaleman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"},{"name":"Department of Pediatric Gastroenterology, Amsterdam UMC, Emma Childrens' Hospital UMC, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hallagan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"},{"name":"College of Medicine, The Ohio State University, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin R.","family":"Halleran","sequence":"additional","affiliation":[{"name":"Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle K.","family":"Orsagh-Yentis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Levitt","sequence":"additional","affiliation":[{"name":"Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Wood","sequence":"additional","affiliation":[{"name":"Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Benninga","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Amsterdam UMC, Emma Childrens' Hospital UMC, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neetu","family":"Bali","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla H.","family":"Vaz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desale","family":"Yacob","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Di Lorenzo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter L.","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1038\/ajg.2008.110","article-title":"Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter","volume":"104","author":"B P Chumpitazi","year":"2009","journal-title":"Am J Gastroenterol"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"3064","DOI":"10.1007\/s00268-016-3693-9","article-title":"Botulinum toxin injection for treatment of chronic anal fissure: is there any dose-dependent efficiency? A meta-analysis","volume":"40","author":"A Bobkiewicz","year":"2016","journal-title":"World J Surg"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1097\/01.PHM.0000137315.17214.93","article-title":"Time course of recovery of juvenile skeletal muscle after botulinum toxin A injection: an animal model study","volume":"83","author":"J Ma","year":"2004","journal-title":"Am J Phys Med Rehabil"},{"issue":"25","key":"ref4","doi-asserted-by":"crossref","first-page":"3268","DOI":"10.3748\/wjg.v25.i25.3268","article-title":"Botulinum toxin injections after surgery for Hirschsprung disease: systematic review and meta-analysis","volume":"25","author":"D Roorda","year":"2019","journal-title":"World J Gastroenterol"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s00383-017-4066-7","article-title":"Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease","volume":"33","author":"J C Langer","year":"2017","journal-title":"Pediatr Surg Int"},{"issue":"11","key":"ref6","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1016\/j.jpedsurg.2019.03.020","article-title":"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","volume":"54","author":"D R Halleran","year":"2019","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jpedsurg.2016.10.023","article-title":"Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia","volume":"52","author":"J T Church","year":"2017","journal-title":"J Pediatr 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Hallagan","year":"2019","journal-title":"Gastroenterology"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.jpedsurg.2020.06.044","article-title":"Can botulinum toxin help in managing children with functional constipation and obstructed defecation?","volume":"56","author":"A B Radwan","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"09","key":"ref18","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/j.jpedsurg.2017.12.020","article-title":"Continence after posterior sagittal anorectoplasty for anorectal malformations: comparison of different scores","volume":"53","author":"G Brisighelli","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"e13294","DOI":"10.1111\/nmo.13294","article-title":"Recommendations for pharmacological clinical trials in children with functional constipation: the Rome foundation pediatric subcommittee on clinical 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