BackgroundHirschsprung’s disease (HSCR) is one of the most common congenital digestive tract malformations and can cause stubborn constipation or gastrointestinal obstruction after birth, causing great physical and mental pain to patients and their families. Studies have shown that more than 20 genes are involved in HSCR, and most cases of HSCR are sporadic. However, the overall rate of familial recurrence in 4331 cases of HSCR is about 7.6%. Furthermore, familial HSCR patients show incomplete dominance. We still do not know the penetrance and genetic characteristics of these known risk genes due to the rarity of HSCR families.MethodsTo find published references, we used the title/abstract terms “Hirschsprung” and “familial” in the PubMed database and the MeSH terms “Hirschsprung” and “familial” in Web of Science. Finally, we summarized 129 HSCR families over the last 40 years.ResultsThe male-to-female ratio and the percentage of short segment-HSCR in familial HSCR are much lower than in sporadic HSCR. The primary gene factors in the syndromic families are ret proto-oncogene (RET) and endothelin B receptor gene (EDNRB). Most families show incomplete dominance and are relevant toRET, and theRETmutation has 56% penetrance in familial HSCR. When one of the parents is aRETmutation carrier in an HSCR family, the offspring’s recurrence risk is 28%, and the incidence of the offspring does not depend on whether the parent suffers from HSCR.ConclusionOur findings will help HSCR patients obtain better genetic counseling, calculate the risk of recurrence, and provide new insights for future pedigree studies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12519-023-00686-x.