Congenital megacolon, also known as anaplasia, is a common congenital intestinal malformation in children due to the absence of ganglion cells in the diseased intestinal segment, resulting in persistent spasm of the intestinal canal, stagnation of feces in the proximal colon, and consequent hypertrophy and dilatation of the colon. Currently, the treatment of congenital megacolon is still mainly surgical. However, is it better to perform a one-time radical surgery directly on a newborn baby? Or should we perform a fistula first and then perform the radical treatment? First of all, we should be clear that congenital megacolon is not a terminal disease, and timely surgical treatment, either a one-time radical surgery or a fistula followed by radical treatment, may be able to cure it completely. However, the choice between direct radical surgery and fistula surgery depends on the age of the child, the length of the diseased intestinal segment, and the severity of the disease. The age of the child is of great concern to both doctors and parents, especially for parents of newborn babies, who urgently need to know whether the newborn can be operated on and what procedure to choose. Although there is no uniform standard for choosing the timing of radical surgery, the newborn period (from the time the fetus is delivered with the umbilical cord ligated until 28 days) can be done, and some believe that it needs to be delayed. Therefore, performing radical surgery in neonates is controversial and each surgeon has his or her own experience. However, based on our years of follow-up and observation of many cases, we believe that radical surgery is performed after 3 to 6 months of age with relatively few surgical complications and sequelae, meaning that it should be done at least until the child is 3 months old.” Experts say. Fistula or conservative treatment before neonatal radical surgery? In cases where the diagnosis of congenital megacolon is relatively clear in the neonatal period, since radical surgery is not yet possible, is this time for conservative treatment or fistula surgery? For example, in children with short-segment megacolon, manual assistance, such as enemas and dilation, makes the stool easier to pass. However, in the case of the long or normal type, the stool is not as easy to pass and there is a higher possibility of dilatation of the intestinal cavity, so a fistula is recommended at this time. In addition, the ability of the parents to perform a fistula or not is also very relevant. In the case of congenital megacolon with short segments or short common type, some parents have good manual skills and are able to maintain the child’s daily bowel movements by means of dilation, enemas, and anal canal venting under the guidance of the medical staff to keep the bowel from being severely dilated, so it is possible not to perform fistula surgery. This operation will continue until the child is 3 months old, and then the child will be examined to see if the indications for a one-time radical surgery are met, and if so, the radical surgery can be done directly. However, if the parents do not know how to give enemas and have problems with dilation, they cannot stop the child’s intestinal tract from expanding, which will affect the results of the later surgery, and then a fistula will be needed. The newborn’s surgical efficacy: fistula + cure > one-time cure For many new parents, it’s not only heartbreaking to see their baby suffer two surgeries, but they’re also worried about whether the baby can withstand two surgeries and whether the efficacy will not be as good as the one-time cure. For children with congenital megacolon, a second radical surgery after 3-6 months may have better long-term results, and the incidence of complications and sequelae may be lower and not unbearable. This is because a small child is more compatible with the indication for surgery through several months of growth and development. In particular, after the fistula surgery, the diameter of the original dilated colonic canal gradually shrinks close to normal, which better matches the diameter of the rectal drag-out and anastomosis through the anus, and better preserves as much of the colon as possible, which is more conducive to improving the surgical results and reducing complications. At the same time, when the child is able to poop on his own, his appetite is better and his physical growth and development is better. At this time, the child’s whole body resistance and weight are no different from normal children of the same age, or even better. In this case, the safety of radical surgery is improved. In addition, if we choose radical surgery in the neonatal period, there may be more complications, and some of them are likely to stay with the child for the rest of his or her life. Therefore, we prefer to wait until the child is older to have the surgery, and there will be relatively fewer complications. Also, although two surgeries are required in the short term, the benefits to the child are greater in the long run for life.