Does congenital megacolon require surgery? The treatment of congenital megacolon has matured after decades of repeated practice. The current view is that after the diagnosis of congenital megacolon is established, all congenital megacolon should undergo radical surgery except for a small number of ultra-short segment types. Without surgery, the normal intestinal canal above the diseased segment can dilate secondary to this pathological change, which becomes more pronounced with increasing age. Delayed surgery often necessitates the removal of the otherwise preserved normal colon, and the intestine cannot regenerate after resection, increasing the chance of postoperative complications. In addition, delayed surgery inevitably results in children with significant or even severe lag in growth and development compared to normal children of the same age. What are the common surgical methods for congenital megacolon? There are many surgical methods commonly used at home and abroad, such as Soave method, Swenson method, Duhamel method, etc. Different surgical methods, but they all have the same goal, i.e., to remove the diseased spastic intestinal segment and part of the secondary dilated colon, restore normal intestinal peristalsis, eliminate abdominal distension and restore voluntary bowel movement. In view of the specific situation in China (e.g. economic ability and traditional concept), the principle of surgery is to cure the disease in a single operation as far as possible. Why do some children with congenital megacolon need staged surgery? Some children with congenital megacolon need to be operated in stages, i.e., stage I enterostomy and stage II radical surgery. The first-stage enterostomy is suitable for children with the following conditions: 1) megacolon crisis due to combined small bowel colitis, 2) partial long-segment megacolon, 3) total colonic megacolon, and 4) patients who cannot tolerate one-time radical surgery for other reasons, such as poor general condition and severe malnutrition. The colostomy should be made at the proximal end of the segment without ganglion cells, usually at the proximal end of the sigmoid colon or transverse colostomy, and the ileostomy should be made for the total colon type. At the time of stoma, the entire proximal intestinal canal should be routinely removed for pathologic biopsy. Usually, 3-6 months after the stoma, a second-stage surgery is performed for radical treatment.