الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In this study, 90 patients in pediatric surgery unit, Assiut University, Children Hospital underwent endorectal pull-through with three different approaches, transabdominal, and transanal and laparoscopic assisted. We concentrated and analyzed all data collected including demographic data (age, sex, associated anomalies, family history), clinical presentations and examinations, diagnostic work up, operative details, immediate, early and late post-operative complications) in three approaches. Mean operative time and estimated blood loss were more or less the same in three approaches and to some extent less in transanal approach and laparoscopic assisted approach the same and little more in transabdominal approach. Immediate postoperative complications were comparable to other series. Transabdominal approach had more hours to starting oral feeding in comparison with transanal and laparoscopic assisted approaches. Early postoperative complications were to some extent similar in three approaches except in transabdominal approach; patients suffered more form post-operative vomiting, distention and wound complications. Late post-operative complications had no significant differences, only concerning incisional hernia which occurred in one case in transabdominal approach. Laparoscopic assisted approach offers many advantages over totally transanal approaches such as: It is exploratory procedure. The transitional zone in most of cases is clearly defined. Long segment cases can be done. Decrease time of anal stretching during operation. Avoiding twisting of pulled-through colon. It has many advantages over transabdominal approach such as: It is minimal invasive procedure. Less postoperative pain. Decrease risk of postoperative adhesions. Short hospital stay. Early return of bowel function. Minimal scar. We believe that laparoscopic assisted endorectal pull-though procedure is a good choice for management of long segment cases of HSD and cases with difficult transanal dissection and needs transabdominal approach. We found good results in three approaches with no significant major difference in outcomes but we recommend using laparoscopic assisted endorectal pull-through in more large series and long term follow up in all types of HSD. Vast majority of difficults facing us in laparoscopic approaches as general are limitations of resources, instruments and economic cost.