Text Box: EVALUATION OF ONE-STAGE TRANSANAL ENDORECTAL PULL-THROUGH FOR HISCHSPRUNG’S DISEASE Shi Chengren, Yu Shiyao, Li Chugang, et al Department of Pediatric Surgery, Xinhua Hospital, Shanghai Second Medical University, Shanghai, China Objective: To evaluate the advantage and disadvantage of new one-stage transanal endorectal pull-through for Hischsprung’s Disease (HD). Methods: 47 children with HD were treated from February 1996 to February 2001, 37 were females and 10 were males, mean age was 3.8 years (range: 2 months to 11 years). 4 were short-segment aganglionosis, 40 rectosigmoid, 2 long-segment and 1 total-colon. The patients were divided into 3 groups: Grob’s procedure (n=25), laparoscopic Soave procedure (LS, n=6) and one-stage transanal endorectal pull-through (TAS, n=16). Factors evaluated included: hospital stay, operating time, cost and complication. Results: Compared with LS or Grob group, TAS had shorter operating time (mean 90 minutes), less blood loss (about 30 ml), lower cost and shorter hospital stay (the children were discharged home 3-7 days after surgery). 31 patients (65.9%) got follow-up. There were few complications in both TAS and LS group. The author paid specific attention to postoperative barium enema studies and the colon “pulled straightly” or excited gastrocolic reflex were not noted. However 2 TAS needed additional left lower quadrant incision: in 1 case the transanal pull-through was difficult and adhesion of partial intestine in left lower quadrant was found during laparotomy ; in another case because the segment being pulled out was too long (56cm), laparotomy was performed for fear that the colon was pulled straightly, and a diverticulum on the ileum was found and resected. Conclusions: The new operative procedure TAS for HD has advantages of no need for laparotomy, less injury, simple technique, lower cost and less complications (such as adhesion of intestine). However, to older children or those with long-segment or total-segment disease, this procedure is hard to perform. The associated malformations can hardly be checked out when using this procedure because the operative field was limited to anal region. TAS with minilaparotomy or laparoscopy is necessary in specific condition (such as adhesion of intestine,et al). 2317