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 the timing of radical surgery, some experts believe it can be done in the neonatal period (from the time the fetus is delivered with the umbilical cord ligated until 28 days), while others believe 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 its surgical complications and sequelae are relatively rare, which means that at least the surgery should be done after the child reaches 3 months of age.” Why choose such a timing for surgery? There are several questionable areas for radical surgery for congenital megacolon in the neonatal period: 1. In some newly born children, the clinical manifestations are not always so clear, leading to a lot of doubts about the diagnosis of congenital megacolon in the neonatal period itself; 2. The common examination and diagnosis methods for congenital megacolon, such as abdominal X-ray and anorectal manometry, have a low diagnostic rate in the neonatal period. In other words, there is a high probability of false negatives or false positives in the neonatal period; 3. The congenital megacolon radical surgery in the neonatal period is relatively more demanding for doctors. If the doctor’s technical operation is not very superb, it may affect the postoperative sequelae or complications of the child, such as feces, poor stool control and such complications will be more. Fistula or conservative treatment before neonatal radical surgery? When the diagnosis of congenital megacolon is clear in the neonatal period, since radical surgery cannot be performed yet, is it better to perform conservative treatment or fistula surgery during this period? The decision depends on which type of congenital megacolon belongs to. For example, in children with short-segment megacolon, manual assistance such as enemas and dilation make the stool easier to pass. However, in the case of long segmental 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. 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 are more able to maintain the child’s daily bowel movements by dilation, enema, and venting of the anal canal under the guidance of the health care provider to keep the bowel from being severely dilated, so it is possible not to perform fistula surgery in this case. 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 outcome 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. The long-term results of a second radical surgery after 3-6 months for children with congenital megacolon may be better, and the incidence of complications and sequelae may be lower and not unbearable. “This is because small children are more compatible with the indications for surgery through several months of growth and development. Especially after fistula surgery, the diameter of the original dilated colon tube gradually shrinks close to normal, which better matches the diameter of the rectal drag-out and anastomosis via the anus, and is better able to preserve as much of the colon as possible, which is more conducive to improving surgical outcomes 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. The safety of performing radical surgery in this case is improved.” ”In addition, if you choose radical surgery in the neonatal period, there may be more complications, and some of them are likely to stay with the child for life. Therefore, we prefer to wait until the child is older to have the surgery, and there will be relatively fewer complications. And, although two surgeries will have to be performed in the short term, the lifelong benefits to the child will be greater in the long run.”