Background. Survey of surgical techniques, strategy and results of the treatment of patients with Hirschsprung´s disease (HD) at the Department of Pediatric Surgery of Charles University, 2nd Faculty of Medicine in Prague from 1979 to 2004 is presented. Methods and Results. Paper summarises a twenty-five years long retrospective study of medical records of 274 patients who were operated on 1979–2004. 173 (67,3 %) pts had classical rectosigmoid (CRA) and/or long colonic aganglionosis (LCA). 19 (6,4%) pts had total colonic aganlionosiswith small bowel involvement (TCA). 72 (26,3%) pts suffered from ultra-short rectal aganglionosis (URA). 74 pts with CRA and LCA operated on 1979–1991 underwent Kasai´s colorectoplasty. 8 (10,8%) of them had anastomotic leak, 7 (9,5%) pts had anastomotic stricture, 2 (2,7 %) pts had postoperative enterocolitis (PEC) and 10 (13,5 %) had chronic constipation. In 6 pts an additional partial sphincteromyectomy of the internal anal sphincter SFME) had to be done. In period 1991–2004 93 pts underwent Swenson’s procedure with (SFME). Anastomotic leak occurred in 3 (3,2 %) pts. Anastomotic stricture, PEC and/or chronic constipation were not registered. In 6 pts with anastomotic leak from both groups Soave re-do pull-through was done. In 2003–2004, 10 pts with CRA underwent a transanal resection of aganglionic segment with Swenson’s colorectoplasty.One pt developed anal stricture. 3 of 19 ptswithTCAoperated on in 1979–1990 underwent classic Martin’s long side to side ileo-recto-colic anastomosis. In 16 pts of 1991–2004 only short ileo-recto anastomosis according to Kasai and/or Swenson were done. In 93 pts suffering from URA a Lynn´s SFME was performed. Three-stage procedure for the last time was used in 3 pts in 1984. Two- and one-stage procedures are still used. Conclusions. A number of postoperative complications decreased, a three-stage procedure was abandonned and the operation of HD is currently performed in newborn. In CRA a TAR replaced the laparatomy and in TCA the short ileo-rectal anastomosis is performed only.

        Key words: Hirschsprung’s disease, intestinal aganglionosis, Swenson’s operation, postoperative enterocolitis, transanal resection.