Transanal Endorectal Pull-through Research Articles

Current status of Hirschsprung's disease: based on a nationwide survey of Japan.

The diagnosis and surgical treatments of Hirschsprung's disease (HD) have undergone various changes in the last few decades because of establishment of laparoscopic procedures. A retrospective nationwide survey for 4 decades was performed to study the changing profile of HD in Japan. The patient data were collected in 4 phases: Group 1, between 1978 and 1982; Group 2, between 1988 and 1992; Group 3, between 1998 and 2002; and Group 4, between 2008 and 2012. The incidence and the male/female ratio remained almost the same over time (1/4, 895 in newborns and 2.9:1 in Group 4). The patients with a family history increased to 7.1% in Group 4, in comparison to 2.8-6.0% in other groups. Regarding the extent of aganglionosis, sigmoid colon increased to 63.1% in Group 4, compared to 51.9% in Group 3. Manometry was performed less frequently in Group 4 (45.8%) than in Group 3 (66.1%). Transanal endorectal pull-through (TAEPT) was the most popular operation in Group 4 (49.6%). In addition, laparoscopy-assisted operations increased to 46.9% in Group 4, in comparison to 29.7% in Group 3. The incidence of preoperative enterocolitis and the mortality rate in Group 4 were 17.2% and 2.4%, respectively, and were markedly decreased in comparison to Group 1 (29.2% and 6.5%, respectively). The mortality rate decreased over time to 2.4% in Group 4. Over the last decade, there has been remarkable improvement in the mortality rate associated with the small intestine (aganglionosis extending orally to more than 30cm of the terminal ileum). The rates were 25.5% in Group 4, 53.6% in Group 1, 33.3% in Group 2, and 35.5% in Group 3. In addition, the mortality rates of the remaining aganglionosis subgroups also improved. Primary operations without laparotomy, including TAEPT and laparoscopy-assisted operations, have become the first choice for the definitive surgical treatment of HD in Japan. The mortality rate has decreased over time. However, the mortality rate of small intestinal aganglionosis is still relatively high. The development of new treatment strategy for small intestinal aganglionosis is called for.

Treatment and Patient Reported Outcome in Children with Hirschsprung Disease and Concomitant Congenital Heart Disease.

Purpose. Congenital heart disease (CHD) is reported to be associated with Hirschsprung disease (HD). The aim was to evaluate any differences between children with HD with and without CHD, respectively, with regard to patient characteristics, medical care, and patient reported bowel function. Method. This is a retrospective chart study and a cross-sectional long-term follow-up of patients older than 4 years old, including all children with HD operated on with transanal endorectal pull-through (TERPT) at a tertiary center of pediatric surgery. Information about patient characteristics, diagnostics, surgery, and medical care was compiled. At long-term follow-up, bowel function was assessed by Bowel Function Score. Results. Included were 53 HD-patients, 13 with CHD and 40 without CHD. Children with CHD more commonly presented with failure to thrive; 4 (23%) compared to those without CHD (0%) (p < 0.01). In the long-term follow-up, including 32 patients (6 with CHD), constipation was more commonly reported by children with CHD 5 (83%) than by children without CHD 4 (27%) (p = 0.01). No differences were shown in the other parameters such as fecal control and incontinence. Conclusion. HD-patients with CHD more commonly presented with failure to thrive and more frequently reported constipation than HD-patients without CHD. The findings indicate that HD-patients with CHD might need special consideration in their initial care and long-term follow-up.

Diagnosis, Symptoms, and Outcomes of Hirschsprung's Disease from the Perspective of Gender.

Background/Aim. Hirschsprung's disease (HD) has a skewed gender distribution, with a female to male ratio of 1 : 4. This study aims to examine differences between boys and girls with HD regarding preoperative features and postoperative treatment and outcome. Method. The first part of the study was conducted as a retrospective review of all HD patients who underwent transanal endorectal pull-through (TERPT). Pre-, peri-, immediate post-, and first-year postoperative data were collected. The second part was conducted as an observational cross-sectional study by comparing bowel function scores (BFS) determined by structured interviews of patients 4 years old and older. Results. Included were 39 boys and 12 girls. Of these, 25 boys and 9 girls were older than 4 years and participated in the BFS interview. Boys had a higher frequency of hospitalizations during the first postoperative year compared to girls (n = 20 and n = 2, p < 0.05). At long-term follow-up, more boys reported abnormal frequency of defecation, 16 compared to 2 (p < 0.05). There was no difference between genders in terms of preoperative symptoms and overall bowel function later. Conclusion. Boys with HD had more hospitalizations and a higher rate of abnormal frequency of defecation than girls with HD.

Redo pull-through surgery in Hirschsprung disease: Short-term clinical outcome

IntroductionAlthough surgery is effective in most patients with Hirschsprung disease (HD), some have persistent obstructive symptoms. Additional medical treatment is generally sufficient, but a small fraction of these patients needs secondary surgery. Series on redo surgery are scarce. Aim of this study is to evaluate complications and clinical outcome of patients in need of redo surgery for HD. Materials and methodsSixteen patients underwent redo endorectal pull-through surgery in our center between 2007 and 2015. Medical records were reviewed and demographics, indication for redo surgery, surgical procedures, complications, and clinical outcome were scored. ResultsThe median age at the time of redo was 4.6years (range: 2months–21years). Median follow-up after redo was 3years (range: 9months–7years). Before redo surgery, all patients (100%) had obstructive symptoms, one patient had recurrent enterocolitis, and four patients were fecally incontinent despite adequate attempts of bowel management. Surgical procedure consisted of a transanal endorectal pull-through (TERPT) in all patients, with additional laparotomy in 7 (44%) and protective stoma in 8 patients (50%). Complications within 30days after redo surgery were anastomotic dehiscence (3; 19%), wound abscess (2; 13%), rectovaginal fistula (1; 7%) or enterocutaneous fistula (1; 7%). During follow-up, nine patients needed additional surgery, mainly to close the stoma. At final follow-up there were no patients with stenosis, obstructive symptoms, remaining rectovaginal fistula, or small bowel obstruction. Only one patient experienced enterocolitis. Six patients (43%) reported soiling or fecal incontinence. ConclusionTERPT for redo surgery for HD is effective in resolving sustained severe obstructive symptoms after primary surgery, but the outcome is complicated by a relatively high rate of soiling and fecal incontinence.

Long-term outcomes of children with transanal endorectal pull-through and a review of the literature

Introduction: The transanal endorectal pull-through (TERPT) procedure, the latest advancement in the surgical treatment of Hirschsprung’s disease, has replaced most other surgical techniques in the last decade.Patients and methods: Between October 2002 and March 2014, a total of 22 patients diagnosed with Hirschsprung’s disease underwent a one-stage TERPT operation.Results: Resected segments included the rectosigmoid (seven patients), the descending colon (10 patients), and the transverse colon (five patients). The minimum length of the resected segments was 15 cm and the maximum length was 65 cm. The mean length was 39.18 ± 12.05 cm. Following surgery, the start of oral ingestion was 1–8 days (mean 3 ± 1.69 days) and the hospital stay after the operation lasted 4–11 days (mean 7.04 ± 2.05 days). The mean follow-up period was 48 ± 6 months (range of 24–166 months). Out of 22 patients, three patients had an anal stricture, which responded to anal dilatations; three patients had an enterocolitis episode that required hospitalization; two patients experienced constipation; and two patients had incontinence/soiling.Conclusion: Our data suggest that the TERPT operation can be safely performed in terms of long-term complications.

An easy-to-source, inexpensive, self-retaining anorectal retractor

Objective: The aim of this study was to build a self-retaining anorectal retractor using easy-to-source components, to use in regular clinical practice. This retractor is used primarily in transanal endorectal pull-through. Materials and methods: The components used to build this retractor were as follows: a set of elastic rubber straps, a set of stainless steel fish hooks, and a frame made of acrylic (plexiglass). Every fish hook was fixed to one end of each rubber strap and used to anchor the anal mucosa. The other end of each rubber strap was stretched over the acrylic frame to achieve the desired degree of retraction. Results: The retractor is effective, providing adequate exposure of the surgical field throughout the pull-through procedure. It is light, yet robust, and reusable. Conclusion: This self-retaining anorectal retractor proved to be a simple-to-build, inexpensive, and effective surgical tool in transanal endorectal pull-through procedure. Keywords: endorectal, hirschsprung, hook, pull through, retractor

Transanal endorectal pull-through for Hirschsprung's disease: experience with 50 patients.

Transanal endorectal pull-through (TEPT) is the latest advancement in the treatment of Hirschsprung's disease (HD). The aim of this study was to evaluate the safety and efficacy of TEPT as a definitive treatment for patients with HD. A retrospective study of 50 patients who underwent TEPT at Uludağ University, Bursa, Turkey, between June 2001 and April 2012 was conducted. These patients were evaluated with regard to their age, sex, preoperative findings, and length of the aganglionic segment, intraoperative and postoperative complications, and results of the follow-up. Forty-three patients were boys and seven were girls. The median age was 3months (range 0-96months). The most common symptoms were abdominal distention and vomiting. HD was diagnosed in 38 patients using barium enema and anorectal manometry, in 11 patients using rectal biopsy, and in 1 patient using laparotomy with biopsy. The mean time from the beginning of enteral feeding was 2.2±1.1days. The mean follow-up period was 26.7±20.8months. The postoperative complications included transient perianal excoriation in 12 patients, enterocolitis in 10, anastomotic stricture in 3, soiling in 3, recurrent constipation in 2, prolapse of the pulled through colon in 1, anastomotic leak in 1, and rectovestibular fistula in 1 patient. TEPT is a feasible and safe procedure in children with rectosigmoid HD.

Transanal Endorectal Pull-Through Procedure for patients with Hirschsprung`s Disease: A prospective study

Back ground: Hirschsprung`s disease is a common problem among pediatric population, many procedures had been implemented in the treatment with different results. In the last decades one stage transanal endorectal pullthrough (TEPT) had come into the stage as a minimal invasive choice for such condition with good results.Objectives: To evaluate the feasibility and safety of TEPT procedure among pediatrics in a tertiary pediatric surgery center in Iraq.Patients and Methods: A prospective study was conducted on 11 patients with Hirschsprung’s disease, attending Central Teaching Hospital of Pediatrics for the period from March 2007 till August 2014. Their ages were ranging from 1 month - 12 years. All cases had diverting colostomy and leveling biopsy. The aganglionic segment was confined to the rectum and rectosigmoid junction. TEPT was done to all cases with closure of colostomy 6-8 weeks after pullthrough. The patients were followed up for a period of 6 months-4 years.Results: The study was conducted on 11 patients with a mean age of (33.7 ± 43.4 months); the male to female ratio was 9:2. Regarding the level of aganglionosis, it was confined to the rectum in 4 cases, while it reached the rectosigmoid junction in 7 cases. The mean operating time was (115.4 ± 23.5 minutes), and the mean volume of blood loss was (37.3 ± 17.6 ml). The average length of resected aganglionic segment was (13.9 cm). There is no conversion to laparotomy in any case. Complications developed in two cases one with perianal excoriation and the other develop postoperative enterocolitis.Conclusion: Transanal Endorectal Pull-Through operation for Hirschsprung’s disease is feasible and safe, and it can be performed successfully in all ages of children with good results avoiding transabdominal exploration.

Are there any factors influencing the course of multistage treatment in Hirschsprung's disease?

IntroductionSurgical treatment of Hirschsprung's disease may be performed in a single step, or in stages with a temporary stoma. The therapy depends on the clinical condition of the patient and the severity of symptoms. Planned multistage treatment is carried out in two or three steps.AimTo analyse our 15 years of experience with multistage surgery for the treatment of Hirschsprung's disease, to identify multistage-related factors influencing the course of surgery and hospitalisation, and to evaluate the probability of complications during multistage treatment.Material and methodsThe study material was collected on the basis of documentation of patients treated during the years 2000 to 2014. The parameters concerning surgery and hospitalisation were statistically analysed.ResultsTwenty nine patients were treated with multistage surgery using the following methods: Duhamel-Martin and Transanal Endorectal Pull-Through (TEPT). There were significant correlations (p < 0.05) between length of resected intestine and operative time. Classification and Regression Tree (CRT) was used to classify the operated children depending on the presentence of complications after surgery.ConclusionsThe incidence of complications during multistage treatment for both methods was comparable. It is difficult to objectively compare the Duhamel-Martin and TEPT techniques because of the different indicators for their use in multistage surgery. Intestinal adhesions were the most common complication after definitive surgery. Younger age of the operated patients was associated with greater risk of adhesion formation.

Single Stage Transanal Endorectal Pull-through Operation for Hirschsprung’s Disease in Neonate: A Single Center Experience

Single Stage Transanal Endorectal Pull-through Operation for Hirschsprung’s Disease in Neonate: A Single Center Experience

سحب القولون عن طريق فتحة المخرج لمرضى شلل القولون الولادي دراسة مستقبلية

سحب القولون عن طريق فتحة المخرج لمرضى شلل القولون الولادي دراسة مستقبلية

TRATAMENTUL MINIM INVAZIV AL BOLII HIRSCHSPRUNG

Introduction. Harold Hirschsprung, a physician at Queen Louise Children’s Hospital of Copenhagen, first described the disease that now bears his name, at the Pediatric Congress of Berlin in 1886. Since then there have been countless debates on the optimal surgical approach. This paper aims both to recap the main classical surgical techniques: Swenson, Duhamel and Soave, but the main focus is on minimally invasive techniques. Surgical techniques. In the last 25 years, the treatment for Hirschsprung disease has progressed. If classically the preferred treatment was in 2-3 stages, now the definitive intervention is per primam in most cases, thus avoiding the morbidity associated with stomas. In 1995, Georgeson describes the minimally invasive approach using laparoscopy, and then in 1998, De la Torre et al, describes the first transanal endorectal pull-through (TERPT), unattended laparoscopically. Discussions. The initial discussions were linked to comparing processes in a single stage with ones in 2 or 3 stages, finding similar results, it is now a question of comparing open techniques with minimally invasive and even minimally invasive techniques with each other, endeavoring to establish whether laparoscopically assisted approach is needed or if the transanal one is enough. Conclusion. Usually shorter forms of Hirschsprung disease are treated strictly using the transanal technique, for the forms involving the left and transverse colon laparoscopically assisted transanal pull-through is used, while for the ascending colon and for the total aganglionosis the laparoscopically assisted Duhamel procedure is preferred.

Clinical and manometric evaluations of anorectal function in patients after transanal endorectal pull-through operation for Hirschsprung's disease: A multicentre study

Aim Transanal endorectal pull-through (TEPT) operation is one the most popular operations for Hirschsprung's disease. This aim of the present study was to evaluate its outcome by clinical and manometric assessments. Patients and Methods This study was a multicentred study involving all three paediatric surgical centres under the Hospital Authority in Hong Kong. All patients, over the age of 3 years, who had undergone primary TEPT operation for more than 1 year, were included in the present study. Clinical evaluation with bowel function score (BFS) and anorectomanometry were carried out. A BFS > 18 and sphincter resting pressure between 30 mmHg and 60 mmHg were considered normal. Those with concomitant anorectal/neurological anomaly or who could not cooperate were excluded. Results A total of 37 patients were enrolled in this study. The median age was 60 months (range: 36–144 months), and the median age at the time of operation was 3 months (range: 0.5–60 months). With respect to functional outcomes, six patients (16.2 per cent) suffered from constipation, but more than two-thirds of patients had satisfactory stool consistency, as well as frequency. Sixteen patients (43.2 per cent) had no report of any soiling. For the BFS, 26 patients had a BFS above 18, with the median value being 16 (range: 7–20). Manometric assessment revealed that 27 patients (72.9 per cent) had sphincteric resting pressure within the normal value, and the median value was 45 mmHg (range: 14–79 mmHg). Rectoanal inhibitory reflex was present in six patients (16.2 per cent), and the median value for the volume of air to elicit the first anal sensation was 41 mL (range: 18–126 mL). Using univariate analysis, long segment disease was identified as a risk factor for developing soiling of more than two times per week [relative risk (RR): 1.87, 95 per cent confidence interval (CI):1.03–2.22, P = 0.05], whereas the creation of stoma (RR: 1.69, 95 per cent CI: 1.41–2.14, P = 0.04) and occurrence of postoperative enterocolitis (RR: 1.58, 95 per cent CI: 1.36–1.0, P = 0.04) were risk factors for abnormal bowel function score. There was no significant risk factor identified for abnormal manometric results. Lastly, patients with abnormal sphincter resting pressure detected in the anorectomanometry study were also more likely to have an abnormal BFS. Conclusion Most patients have satisfactory clinical and manometric outcomes after primary TEPT operation. Anorectomanometry findings can predict clinical outcomes. Patients with long segment disease, development of enterocolitis and stoma creation before operation will need more attention, as they are prone to develop abnormal bowel function. Early interventions, such as manometric assessment and proper bowel management, are recommended in order to correct bowel dysfunction, as well enabling patients to have a better quality of life.

Comparative Study between One Stage Total Transanal Endorectal Pullthrough and Assisted Transanal Soave for Treatment of Hirschsprung’s Disease

Comparative Study between One Stage Total Transanal Endorectal Pullthrough and Assisted Transanal Soave for Treatment of Hirschsprung’s Disease

Early Experience With Single-Stage Transanal Endorectal Pull Through For Rectosigmoid Hirschsprung’s Disease

On 24th August 2015, the spelling of the third author's name was changed from Dhaubhadel TO Dhoubhadel - Editor.Introduction: Recent trends in surgery for Hirschsprung’s disease (HD) have been towards earlier operation and fewer surgical stages. A single-stage transanal endorectal pull through (TEPT) is the latest development and minimally invasive technique for HD. This observational prospective study was designed to evaluate the safety and efficacy of single-stage TEPT technique in the management of rectosigmoid HD.Materials and Methods: Infants and children with biopsy-proved aganglionosis and barium enema (BE) documented rectosigmoid HD were included for single stage TEPT. Twenty children aged 22 days to 7 years (17 boys and 3 girls) underwent one stage TEPT over 5 year period. Median follow up was 18 months (range 6-36 months). These patients were evaluated with regard to age, sex, intraoperative details, postoperative functional outcome and complications and need for secondary surgical procedure.Results: The operating time was 105-180 minutes (mean 120 minutes). The length of resected bowel was 18-30 cm (mean 25 cm). Intraoperative blood loss was 5-40 ml, less in infants compared to older children. Blood transfusion was needed in none out of 12 infants and 2 out of 8 older children. Transient perianal excoriation occurred in 16 patients. Postoperative enterocolitis occurred in one patient. One patient developed constipation with encopresis following anastomotic stricture. None had adhesive obstruction and prolapse of pulled through colon, one required colostomy for anastomotic leakage and peritonitis while another had retained aganglionic segment and re-do pull through was required.Conclusion: Single-stage TEPT can be performed successfully in all age of children. The technique is safe, easily learned and has good clinical results.DOI: http://dx.doi.org/10.3126/jnps.v34i3.11617 J Nepal Paediatr Soc 2014;34(3):188-194

A population-based, complete follow-up of 146 consecutive patients after transanal mucosectomy for Hirschsprung disease

ObjectiveThe objective of the study is to define the population-based bowel functional outcomes and enterocolitis following transanal endorectal pull-through (TEPT) in patients with Hirschsprung disease (HD) treated at our institution between 1986 and 2011. Methods146 consecutive patients who had undergone primary surgical treatment for HD were included. The median follow-up time was 15 (3–33) years. The clinical details and prevalence of enterocolitis were evaluated in all patients, and bowel function in patients >3years of age with functional intestino-anal continuity. ResultsNo patients were lost to follow-up. Overall survival was 98%. The level of disease was rectosigmoid in 83%, long segment in 7%, total colonic in 4%, and extending up to the small bowel in 6%. 29% had an associated syndrome. 22% had a preoperative stoma. Operations included TEPT (89%), proctocolectomy with ileoanal anastomosis in 9%, and 3% had a permanent endostomy owing to small intestinal aganglionosis. One patient underwent intestinal transplantation. At the latest follow-up, 42% had occasional soiling, 12% had frequent soiling and 46% had no soiling.Constipation occurred in 9%. An associated syndrome was the only predictor for soiling or constipation (OR 4.3, 95% CI 1.5–12). 44% developed recurrent postoperative enterocolitis, which was predicted by extended aganglionosis (OR 6.9, 95% CI 2.4–20) and syndromatic disease (OR 2.4, 95% CI 1.2–5.0). ConclusionThe major functional sequelae following TEPT were recurrent enterocolitis and fecal soiling, which was mostly occasional. An associated syndrome was a predictor of a reduced bowel functional outcome, and alongside extended aganglionosis were significant risk factors for recurrent postoperative enterocolitis.

Anal endosonography and bowel function in patients undergoing different types of endorectal pull-through procedures for Hirschsprung disease

BackgroundThe reasons for fecal incontinence after surgery for Hirschsprung disease (HD) remain unclear. The aim of this study was to examine the anal sphincters by anal endosonography and manometry after transanal endorectal pull-through, with or without laparotomy or laparoscopy, in HD patients. Furthermore, we aimed to correlate these findings to bowel function. Patients and methodsFifty-two HD patients were followed after endorectal pull-through. Anal endosonography and manometry were performed without sedation at the age of 3 to 16years. ResultsEndosonographic internal anal sphincter (IAS) defects were found in 24/50 patients, more frequently after transanal than transabdominal procedures (69 vs. 19%, p=0.001). In a multiple variable logistic regression model, operative approach was the only significant predictor for IAS defects. Anal resting pressure (median 40mm Hg, range 15–120) was not correlated to presence of IAS defects. Daily fecal incontinence occurred more often in patients with IAS defects (54 vs. 25%, p=0.03). ConclusionsPostoperative IAS defects were frequently detected and were associated with daily fecal incontinence. IAS defects occurred more often after solely transanal procedures. We propose that these surgical approaches are compared in a randomized controlled trial before solely transanal endorectal pull-through is performed as a routine procedure.

Effect of endorectal pullthrough on external anal sphincter integrity (in cases of Hirchsprung’s disease) using EMG

ObjectiveThe transanal mucosectomy of the aganglionic segment is a critical step in the transanal endorectal pullthrough procedure for the treatment of Hirchsprung’s disease. It exerts considerable traction on the anorectal tissue during dissection. Anal sphincter electromyography (EMG) is an indisp

Transanal Endorectal Pullthrough for Hirschsprung’s Disease Without Frozen-Section Biopsy Facility

Objective: The purpose of this study was to evaluate results of treatment of patients with Hirschsprung’s disease (HPD) by transanal endorectal pull-through (TEPT) in a setting where frozen-section biopsy facility was not available.Methods: From November 2001 to September 2007, fortytwo patients with HPD had undergone TEPT in Rajshahi Medical College Hospital (RMCH) and at various clinics in Rajshahi. The age of the patients ranged from 7 days to 12 years. In all cases, the extent of aganglionosis was limited to recto-sigmoid region and was assessed by the three classical features of contrast enema namely spastic aganglionic zone, transition zone (TZ) and proximal dilated zone (PDZ). During operative pull-through, transition zone (TZ) and proximal dilated zone (PDZ) were identified by naked eye and correlated with x-ray findings. Eleven patients had colostomy fashioned prior to the TEPT procedure. Followup was done for 14 to 58 months (mean 36 months).Result: Thirty-nine patients had satisfactory outcome without any complication. The mean operative time was 100 minutes. The average length of resected gut was 22 cm. Post-operative recovery was smooth and oral feeding was resumed after a mean period of 48 hours. Of the eleven children with colostomy, 6 were older than 10 years with huge megacolon, and the remaining five had their colostomy done at the referring hospital. In 4 patients out of 42, naked eye assessment of the TZ and PDZ and their correlation with the x-ray features were not possible. In such situation, a few cm more of the proximal ganglionic gut from PDZ was resected. Three children out of 42 developed complications; postoperative enterocolitis in two and intra-abdominal bleeding from sigmoid mesocolon in one. There was no incidence of cuff abscess, anastomotic leak, retained segment, encopresis or constipation.Conclusion: The minimal invasive procedure TEPT involves less time with trifle morbidity and offers rapid recovery with shorter hospital stay. The functional outcome is also excellent with small complication rate. The naked eye correlation of the morbid features of rectum and colon in HPD with classical x-ray features is reasonably consistent and TEPT can safely be performed where frozen-section facility is not available.Birdem Med J 2014; 4(2): 84-87

Single Stage Transanal Pull-Through for Hirschsprung’s Disease in Neonates: Our Early Experience

Objective: Hirschsprung’s disease is one of the common causes of intestinal obstruction in neonates. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung’s disease. In this study, we present our early experience with single stage transanal pull through in neonates. Design: Retrospective study of neonates with single stage transanal pull-through done for Hirschsprung’s disease in our institute from January 2011 to January 2013. Material and Method: Five newborn boys who presented with Hirschsprung’s disease were studied. The selection criteria included radiological transition zone at rectosigmoid or mid-sigmoid region, weight more than 2 kg, no evidence of enterocolitis or sepsis and no associated major anomaly. Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years. Results: Five patients with a mean age of 26.4 days (range 15-45 days) and a mean weight of 2.6 Kg (range 2.2 to 3.7 Kg) underwent transanal endorectal pull through. The mean operating time was 68 min (range 60 to 120 min). The average intra-operative blood loss was 20 ml (range – 10 to 30 ml) and the average length of bowel resected was 12.8 cm (range – 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic site. Three patients developed perianal excoriation and one patient had post-operative enterocolitis. No mortality occurred in the series. Conclusion: Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in pre-operative and post-operative management and nursing care has made single stage transanal pull-through in neonates a feasible option. The early results are comparable to single stage or multistage surgery in older children.