• Tam Paul K H PK Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. Electronic address: paultam@hku.hk..
• Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. Electronic address: paultam@hku.hk.
• J. Pediatr. Surg. 2016 Jan 1; 51 (1): 18-22.

Background/PurposeUnderstanding the true nature of the disease provided the basis for appropriate surgery for Hirschsprung's disease some 60 years ago. Nevertheless, surgical outcome remains unsatisfactory. Advances in diagnosis and treatment will depend on the elucidation of the pathogenesis and disease heterogeneity.MethodsThis lecture outlines the author's attempt in the past 30 years to bridge some of the gaps of knowledge in Hirschsprung's disease.ResultsStudies of human fetal gut and aganglionic gut gave insight into the complexity of the human enteric nervous system, but the more fruitful studies came from genetic studies in which disease-causing genes were discovered, and the importance of noncoding mutations conferring disease susceptibility was unraveled. Animal models and pluripotent stem cell studies allowed elucidation of the interacting gene-cell-microenvironment signaling pathways for neural crest proliferation, migration, and differentiation.ConclusionHirschsprung's disease has been a bridge for science and surgery. An integrative approach could provide breakthroughs in the diagnosis and treatment strategies of this complex condition, leading to improved outcome.Copyright © 2016 Elsevier Inc. All rights reserved.

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