Background: Single-incision laparoscopic endorectal pull-through (SILEP) has gained attention as a minimally invasive alternative to conventional laparoscopic surgery (CLS) for Hirschsprung’s disease (HD). While SILEP offers superior cosmetic outcomes and reduced postoperative morbidity, its feasibility, safety, and functional outcomes in neonates remain underexplored. This study aimed to prospectively evaluate the outcomes of SILEP in neonates with HD. Patients and methods: Between January 2020 and December 2021, 23 neonates (≤28 days of age) underwent SILEP at our institution. The procedure involved a 1.5 cm supra-umbilical incision with three fascial punctures for instrument placement, followed by laparoscopic mobilization and modified Soave endorectal pull-through. Perioperative outcomes, postoperative complications, bowel function (BFS), and scar cosmesis (MSS) were assessed. Results: The mean age was 22.3 ± 3.2 days (range: 17–28 days). The mean operative time was 53.8 ± 11.9 min, and the mean hospital stay was 4.5 ± 1.1 days. No intraoperative complications or conversions were recorded. The reoperation rate was 4.3 %, and enterocolitis occurred in 17.4 % of patients. At a mean follow-up of 45.2 ± 3.9 months, 84 % of patients achieved good-to-excellent bowel function (mean BFS = 17.5 ± 2.0). Cosmetic outcomes were highly favorable (mean MSS = 6.1 ± 1.4). Conclusion: SILEP is a safe and feasible approach for managing HD in neonates, demonstrating favorable medium-term bowel function and excellent cosmetic outcomes. While the results are encouraging, further comparative and long-term studies are necessary to clarify its advantages over conventional approaches. Level of Evidence Rating: Level III.
