Adult (or late-onset) congenital megacolon can cause severe constipation, with patients often unable to pass stool without enemas or rectal stimulation, usually after the age of 10 and often in adulthood. The cause is a lack of ganglia in the recto-anal canal, usually 2 cm or less from the dentate line (i.e., less than 3.5-4 cm from the anal verge) in the ganglia-free segment of the bowel. A colonic transmission test, rectoanal manometry, and rectal biopsy are required to establish the diagnosis. Modalities of surgery: transanal inter-anal sphincter rectal resection, coloanal anastomosis, prophylactic colostomy. This procedure can be done laparoscopically to complete the abdominal free, which can avoid the abdominal open incision (poke only) and can make the surgery less traumatic.