One-stage transanal surgical technique for Hirschsprung's disease: is the age of a patient a limiting factor?

Hirschsprung's disease in the adolescent is a rare and often misdiagnosed cause of lifelong refractory constipation. In this particular case, a male patient spent 13 years with an unrecognized illness that was eventually diagnosed as Hirschsprung's disease. The age of the patient is considered a limiting factor due to over-distention and hypertrophy of the rectosigmoid colon that has to be pulled through a muscular cylinder in a limited operative field. This report of a successfully treated teenage boy using a one-stage transanal endorectal approach without conversion to laparotomy, his uneventful recovery and excellent functional results supports the opinion that practically all patients with Hirschsprung's disease can be treated using this technique, regardless of age and size of colon, on condition that the operation is performed by experienced surgeons familiar with classic operative procedures to avoid possible operative pitfalls.