Aim: Idiopathic megarectum and/or megacolon with slow-transit constipation refractory to medical 
management is an indication for surgery. Non of the surgical options available proved satisfactory. TransRectal Abdominally Assisted Pull Through Operation, is a new modification of the Soave's operation to 
avoid deep pelvic dissection, and injury of the short vasa recta in adults.
Methods: Thirty patients were included in the study with the colonic transit test greater than 96 hours, with 
the barium enema showing megarectum and/or mega- left side colon, and anal manometry was shown to be 
normal. Patients diagnosed with chronic idiopathic constipation according to the scoring system reported by 
Altamore et al.(15) which was performed for all patients preoperative, one month after stoma closure, and 
one year postoperative. Anal myectomy was done for all patients, 25 patients did not improve and required 
trans-rectal abdominally assisted pull through operation.
Results: Patients who were operated upon by abdominally assisted pull through operation showed 
significant postoperative improvement of their constipation scores after three months, and one year 
respectively.
Conclusion: Trans-rectal abdominally assisted pull through operation is a promising new technique in 
patients with medically resistant mega-rectum showing good short term results but still long term form 
follow up awaited.