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Transanal pull-through is currently one of the most commonly used operation to treat Hirschsprung's disease (HD) worldwide. It has undergone some technical modifications during the last decades and still contains variable surgical practices. As high quality comparative studies between different surgical approaches are missing, debate over the optimal operation for HD still continues. Transanal pull-through is associated with multiple potential complications, which may result in permanently impaired functional outcome, life-long morbidity, and significant social restrictions. Although some of the surgical complications can be successfully managed by repeated surgery, the best changes for optimal bowel function and fecal continence are lost. Surgical complications are best treated by efficient prevention with careful adherence to established surgical techniques and principles during the primary operation.