Summary and ConclusionHirschsprung’s disease is a developmental disorder of enteric nervous system characterized by absence of ganglion cells in the myenteric and submucosal plexuses along a variable portion of the distal intestine. It is a relatively common cause of intestinal obstruction in the newborn occurring in approximately one of every 5000 live birth.Diagnosis of Hirschsprung’s disease based on the clinical picture (failure to pass meconium, constipation, abdominal distention, failure to thrive) and investigation (barium enema, rectal biopsy).Soave’s operation of abdomino-perineal endorectal pull-through was introduced by Franco Soave in the early 1960. The procedure consisted of removing the mucosa and submucosa of rectum and pulling ganglionic intestine through the aganglionic muscle cuff, the procedure was modified by Boley who performed a primary anastomosis at the anus.The transanal endorectal pull-through for treatment of Hirschsprung’s disease is considered a development of the technique of modified Soave where all steps of operations is done transanally by which submucosal dissection, resection of aganglionic segment and bringing the ganglionic intestine to the anus and performing anastomosis is done.In our study 50 patients of short segment HD. ranging between 1 month to 14 years of age with male: female ratio 4: 1 were divided into 2 groups:Group I: 20 patients were operated upon using the transabdominal endorectal pull-through (modified open Soave)Group II: 30 patients were operated using the transanal endorectal pull-throughThis comparative study was carried out by one surgical team and the results in both groups were comparable as regards the final outcome in eliminating the pathology. The different complications encountered in both groups were not statistically significant.The results of both groups are summarized as the following:Intraoperatively, mean amount of blood loss was 51.6ml in group II versus 110 ml in group I and the need for blood transfusion was 13.3% in group II versus 35% in group I. Mean length of excised segment was 27cm in group II and 30 cm in group I. Mean operative time was shorter in group II (97.5 minutes) than in group I (150 minutes).The early postoperative course in group II was characterized by rapid starting oral feeding within 24 hours in 90 % of cases and short hospital stay with a mean 3 days. On the other hand, 80% of cases of group I started oral feeding after 2- 4 days and mean hospital stay was7 days.There were no incidences of anastomotic leakage, wound infection, postoperative bowel obstruction, prolonged ileus, cuff stenosis or bleeding in group II, however, in group I there were incidences of anastomotic leakage (5%), wound infection (10%), and postoperative bowel obstruction (10%).Postoperative enterocolitis occurred in 10% of cases in-group II versus 15% in-group I, all responded to conservative management except one case in-group I died from septic shock.Postoperative anastomotic stricture occurred in 10% of cases in both groups and all responded to regular anal dilatation.10% of cases in both groups complained of early soiling that improved completely within the first 3 postoperative months and the incontinence not recorded in any cases above 3 years old age.There was one case in-group II had recurrence of symptoms due to residual aganglionosis and required redsurgery using the same transanal approach.Based on this study we conclude that:* Transanal endorectal pull-through (TEPT) is a new technique for surgical correction of short segment Hirschsprung’s disease and offers many advantages such as:It is a one-stage procedure.Less time consuming.Minimal blood loss.Eliminate the risk of intra abdominal pelvic dissection and injury to the organs and adhesion formation.Better cosmetic results (no visible scars).Less postoperative pain.Rapid return of bowel function.Short hospital stays.No incidence of anastomotic leak.No incidence of adhesive intestinal obstruction.Low incidence of rectal stricture.Therefore we suggested that, this technique is the method of choice for surgical correction of the classic rectosigmoid cases of Hirschsprung’s disease (80 % of cases).* This technique should not be used for the correction of long segment Hirschsprung’s disease, as it would be technically difficult and hazardous to dissect a very long segment of colon through the transanal approach. Also, the technique is not suitable for the hugely dilated hypertrophied colon.*It is worth to be mentioned that the transanal procedure needs a special experience and it has to be born in mind that laparotomy or laparoscopy may be resorted to any time if any difficulty was encountered during the procedure.*Further studies are needed to detect the long term outcome regarding bowel function, intestinal obstruction and continence in patients operated upon using the transanal approach and also the feasibility of this technique in redo surgery for recurrent HD.*On the other hand, modified Soave’s operation is still a well-established & valuable technique for the management of Hirschsprung’s disease and gained popularity worldwide through it is avoiding the pelvic dissection with all its squeals. It’s role is highly appreciated in difficult cases with long segment Hirschsprung’s disease, in patients with leveling colostomy or in situations where there is no enough surgical experience to perform the transanal approach.