Background: Hirschsprung's disease (HD) is one of the commonly studied diseases among pediatric surgeons and researchers. It is also known as intestinal aganglionosis, which is a kind of birth defects mainly expressed as partial or complete absence of ganglion cells of the intestinal tract. Objective: The aim of the current work was to evaluate the management of children with Hirschsprung's disease by one stage pull-through Soave procedures (transanal and trans-abdominal one stage pull-through) concerning perioperative, short term outcomes and complications. Patients and methods: This randomized controlled trial study included a total of 32 patients subjected to transanal and transabdominal one stage pull-through procedures for management of Hirschsprung's disease. Patients were recruited from the Inpatient Clinic, Pediatrics Surgical Department, Assiut University Hospitals. This study was conducted between April 2015 to March 2019 and followed up at our clinics. Results: Comparison of the rates of late post-operative complications among the studied groups revealed that regarding post-operative incontinence, group A had statistically insignificant (p = 0.723) lower rates (50%) compared with group B (56%). Likewise, rates of adhesive intestinal obstruction were insignificantly (p = 0.310) higher (6.2%) in comparison with group B (0%). There was statistically significant (p = 0.001) longer duration of hospital stay among patients in group A (11.1 ± 6.4days) compared with patients in group B (5.0 ± 1.4 days). Conclusion: It could be concluded that the advantages of TERPT include a good cosmetic effect, short hospital stays, safe, and less surgical site infection compared to transabdominal procedures.