A study published in the Journal of Pediatric Surgery compared results of Botulinum Toxin injections with and without ultrasound (US) guidance. In this retrospectively review, the efficacy of Botulinum Toxin injections into the internal anal sphincter (IAS) for obstructive defecation was evaluated over five years. The study assessed 12 patients who underwent Botulinum Toxin injection, including five patients who underwent injections, both with and without ultrasound. Among these patients, ten underwent an ultrasound-guided injection – 13 injection procedures, five of whom had Hirschsprung’s Disease (HD). Whereas, seven patients underwent an injection without ultrasound guidance – 17 injection procedures, five having HD. The findings showed that procedures performed with US resulted in greater short-term improvement, that is, 76% improvement with ultrasound and 65% without ultrasound, and less requirement of a definitive procedure for obstructive defecation. Thus, it was inferred that US-guided Botulinum Toxin injection is safe and effective for obstructive defecation, and may decrease the need for a definitive operation.