Abstract： Objective:To explore the effect of type A botulinum toxin(BTX-A)on recurrent constipation after pull-through procedure for Hirschsprung disease(HD).Methods:Retrospective analysis was performed for 19 children of recurrent constipation after pull-through surgery receiving an injection of BTX-A into internal anal sphincter from January 2015 to June 2020.Basic profiles of pull-through surgery were recorded.The relevant parameters included anorectal manometry, Wexner constipation score and incidence of abdominal distension and enteritis, baseline values and at 1/3 months post-injection.The complications of BTX-A injection were also recorded during follow-ups.Chi-square test was utilized for examining the differences with categorical variables.And t-test or analysis of variance was employed for comparing continuous variables.Results:At Month 1/3 post-injection, resting anal pressure, resting rectal pressure and Wexner constipation score declined.The differences were not statistically significant.After BTX-A injection, 18 cases of abdominal distension and 17 cases of enteritis symptoms were alleviated.Statistically significant differences existed in abdominal distension and enteritis symptoms between before and after BTX-A injection(all P<0.001). Eight patients(42.1%)received multiple injections of BTX-A due to recurrent episodes of obstruction.Five cases(26.3%)had anal pain after injection. Conclusions:BTX-A injection significantly lowers the incidence of obstruction in children with recurrent constipation after pull-through surgery for HD.