A new approach to total colonic aganglionosis

Two babies with total colonic aganglionosis treated by a modified Martin-Duhamel procedure are described. Ileostomy, long side-to-side ileocolic anastomosis and Duhamel's pull-through were the sequence of steps in this staged management. Neonatal ileostomy followed by ileocoloplasty proximal to the ileostomy facilitates home management of the new born patient who then produces well formed stools. This approach avoids neonatal pull-through and obviates the need for parenteral alimentation.