Patient selection for lap assisted, transanal pull through in Hirschsprung disease

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns -

"The diagnosis of HD must be confirmed by an experienced, reliable pathologist with a rectal biopsy. This technique is best suited for short-segment disease, and ideally the patient would have a barium enema study demonstrating a distal transition zone. Longer segment disease is a relative contraindication for this surgical option, and these patients may be better served by a Duhamel procedure l. Prematurity is a relative contraindication, as these patients may not have fully mature ganglion cells and histologic evaluation of biopsies may therefore not be reliable. The patients are managed with rectal stimulation and irrigation until term. Strict contraindications include significant malnutrition, active enterocolitis, or massively dilated proximal bowel; these patients should undergo a staged procedure, with an initial colostomy and a definitive operation once the contraindication has resolved."