Does transitional zone pull-through in Hirschsprung’s disease imply a poor prognosis?

Counting myenteric ganglion cells in histologic sections: an empirical approach

“…One context in which ganglion cell density may be particularly important is the transitional zone (TZ) of HD, a hypoganglionic length of bowel that lies proximal to the segment of aganglionosis and varies from a few millimeters to several centimeters in length [7][8][9][10][11]. Some studies suggest that failure to resect the TZ along with the aganglionic segment may account for the postoperative obstructive symptoms observed in many HD patients [10,12,13], but conflicting data exist [14]. Isolated hypoganglionosis (independent from HD) is also a putative cause of pseudoobstruction [15][16][17][18][19][20].…”

Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not

“…Given the difficulty in precisely characterizing the transitional zone, resection of additional ganglionated bowel has been suggested by some authors to optimize the function of the proximal bowel [18][19][20][21]. The optimal length of resection of proximal ganglionated colon is unknown but has been suggested to range from 2 cm up to 10 to 15 cm [22,23].…”

Developmental anomalies of the enteric nervous system in normoganglionic segments of bowel from rats with total colonic aganglionosis

“…However, a subgroup of HD patients continue to have persistent bowel dysfunction such as constipation Fig. 1 and incontinence, or diarrhea when they get colds etc, or enterocolitis [4][5][6][7]. Concomitant IND [4], acquired aganglionosis [6], and transitional segment colon pull-through [7] have been raised as possible explanations for such post-operative problems.…”

“…1 and incontinence, or diarrhea when they get colds etc, or enterocolitis [4][5][6][7]. Concomitant IND [4], acquired aganglionosis [6], and transitional segment colon pull-through [7] have been raised as possible explanations for such post-operative problems. However, in the majority of HD cases with persistent bowel dysfunction, the exact cause remains unknown because biopsies of pulled-through colon in these patients usually contain normal and mature GC on H-E staining.…”