Recently, we began using minimal access techniques to perform a primary pull-through without a preliminary stoma in children of all ages (range 1 month to 8 years old) with Hirschsprung's disease (HD). To evaluate our results, we reviewed the medical records of all children treated for HD (n = 32) over the past 3 years to compare the outcome of the laparoscopic-assisted pull-through (LAP, n = 14) to standard open pull-through (OPEN, n = 18). The mean ages at diagnosis and presenting symptoms were similar between the 2 groups. Constipation was the most common complaint (LAP, 9, OPEN, 10) followed by persistent emesis (LAP, 2, OPEN, 5), enterocolitis (LAP, 2, OPEN, 2), and failure to thrive (LAP, 1, OPEN, 1). The operative time for the pull- through was similar between the two groups, but the total operative time was longer in the OPEN group when the additional time required for colostomy was included (p < 0.05). Hospitalization after laparoscopic-assisted pull- through was shorter than after the Duhamel procedure (2.5 ± 3.5 days vs. 5.3 ± 1.9, LAP vs. OPEN, p < 0.01). Follow-up was similar between groups (6.7 ± 3.2 months vs. 12.2 ± 14.4, LAP vs. OPEN). Complications in the LAP group included diarrhea (1), and enterocolitis (2), and only 1 child required a secondary procedure (sphincterotomy). Morbidity in the OPEN group included bowel obstruction (3), constipation (3), prolapsed ostomy (2), enterocolitis (1), failure to thrive (1), and aganglionosis (1). Secondary operations required in the OPEN group included division of a 'spur' surgical reduction of intussusception, operative extraction of a fecaloma, sphincterotomy, redo- colostomy and pull-through, revision of ileostomy, and adhesiolysis (2). The number of bowel movements was similar in both groups. Two children in the OPEN group take Imodium for loose stool and another child has soiling problems. Our preliminary results suggest that LAP is superior to OPEN. Advantages include no need for ostomy care, shorter total operative time and hospitalization, and fewer complications.