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Related Experiment Videos

Hirschsprung's disease: problems with transition-zone pull-through.

S I Ghose1, B R Squire, M D Stringer

  • 1Departments of Paediatric Surgery and Pathology, Clarendon Wing, Leeds General Infirmary, Leeds, UK.

Journal of Pediatric Surgery
|December 2, 2000
PubMed
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Transition zone pull-throughs in Hirschsprung

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Histopathology

Background:

  • Hirschsprung's disease surgery requires anastomosing ganglionic bowel to the lower rectum or anal canal.
  • A transition zone (TZ) with subtle innervation abnormalities exists above the aganglionic bowel.
  • The functional impact of TZ pull-through (TZPT) on surgical outcomes is understudied.

Purpose of the Study:

  • To determine the incidence of TZPT in pediatric Hirschsprung's disease surgery.
  • To identify the causes of TZPT, including surgical and histopathologic errors.
  • To evaluate the long-term functional consequences of TZPT and revisional surgery.

Main Methods:

  • Retrospective study of pediatric patients treated between 1979 and 1994.
  • Detailed review of surgical records and histopathologic materials for TZPT cases.

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Main Results:

  • Thirteen cases of TZPT were identified.
  • Histopathologic errors (missed asymmetrical TZ, unrecognized TZ features) were implicated in 12 cases; 1 case involved surgical error.
  • TZPT led to severe functional issues, including incontinence and need for repeat surgery, with disappointing outcomes.

Conclusions:

  • TZPT results from surgical and histopathologic errors, particularly with single-point biopsies and unrecognized subtle histologic features.
  • Functional consequences of TZPT are severe, including constipation, diarrhea, and incontinence.
  • Revisional pull-through surgery yields poor results, suggesting consideration of alternative procedures like the antegrade continence enema operation.