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A rapid lactate dehydrogenase histochemical method for the intraoperative assessment of Hirschsprung's disease
Ning Li1, Lei Xiang, Xiaojuan Wu
1Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Fast lactate dehydrogenase (LDH) staining accurately identifies Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Histopathology
Background:
- Hirschsprung's disease (HD) diagnosis relies on identifying aganglionic bowel segments.
- Accurate delineation of the abnormal bowel segment is crucial for successful surgical resection in HD.
- Current diagnostic methods can be time-consuming, potentially impacting intraoperative decision-making.
Purpose of the Study:
- To evaluate the efficacy of a rapid lactate dehydrogenase (LDH) staining technique.
- To assess its utility in determining the boundary of abnormal bowel in Hirschsprung's disease (HD) for surgical guidance.
- To compare outcomes with traditional frozen H&E staining.
Main Methods:
- Seventy children diagnosed with HD were divided into two groups: study (fast LDH staining) and control (frozen H&E staining).
- Intraoperative diagnosis was confirmed postoperatively using paraffin H&E staining.
- Patient follow-up included bowel function scoring and comparison between groups.
Main Results:
- Fast LDH staining demonstrated 100% concordance with postoperative H&E diagnosis for HD and associated disorders (HAD).
- The control group showed discrepancies between intraoperative and postoperative diagnoses, with several HAD cases missed initially.
- The study group achieved significantly higher bowel function scores postoperatively compared to the control group.
Conclusions:
- Rapid LDH staining is a reliable and fast method for intraoperative diagnosis of HD and HAD.
- This technique aids in precise surgical resection by clearly identifying ganglion cells.
- Utilizing fast LDH staining can lead to improved patient outcomes and prognosis in Hirschsprung's disease management.
Purpose:
The aim was to assess the ability of a fast lactate dehydrogenase (LDH) staining technique to evaluate the boundary of the abnormal bowel segment in Hirschsprung's disease (HD) as a guide for surgical resection.
Methods:
Seventy children diagnosed with HD were equally divided into two groups. For the study group, fast LDH staining was used to confirm the diagnosis and determine the boundary of abnormal bowel. Frozen H&E staining was applied to the control group. Postoperatively, bowel samples were examined by paraffin H&E staining to confirm the intraoperative diagnosis. Patients received a follow-up analysis, and bowel function was scored and compared between the two groups.
Results:
In the study group, 19 children were diagnosed with isolated HD, and the remaining had HD in combination with HD-allied disorders (HAD). The diagnosis was identical to the post-operative H&E staining, and the ganglia cells at the proximal end of the resected bowel were normal. In the control group, 30 children were diagnosed with isolated HD. However, the paraffin H&E staining showed that only 16 cases had isolated HD, and the remaining had a combined diagnosis of HAD. Moreover, 12 of these allied disorders were found at the proximal end of the resected bowel. Patients received follow-up for 6-15 months. The bowel function score of the study group was significantly higher than the control group.
Conclusions:
Fast LDH staining can clearly identify ganglion cells and rapidly diagnose HD and HAD intraoperatively. In addition, this method is helpful for improving patient prognosis.
