Intestinal neuronal dysplasia as a cause of surgical failure in Hirschsprung's disease: A new modality for surgical management

Clinical outcome in children after transanal 1-stage endorectal pull-through operation for Hirschsprung disease

“…The longer the length of the colon that was removed, the more severe the presentation will be, and the more the stool disorders were. Meanwhile, it has been reported that suggested explanations for suboptimal outcome after operation also included associated achalasia of the internal anal sphincter [19,20], neuronal intestinal dysplasia [21], and significant neurological impairment [19,22], all of which may result in abnormal colonic motility in the remaining ganglionic bowel.…”

Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung's disease in children

“…Ischemia may result in anastomotic leak, ischemic colitis, and adverse effects on colonic motility [25,26]. Other factors that may result in suboptimal outcomes after operation also include achalasia of the internal anal sphincter [21,22,27,28], neuronal intestinal dysplasia [29,30] and significant neurological impairment, and enterocolitis [31,32], all of which may result in abnormal colonic motility in the remaining ganglionic bowel.…”

An approach to minimize postoperative enterocolitis in Hirschsprung's disease

“…Postoperative EC is also a severe condition accounting for a substantial number of reoperations and is associated with a mortality rate of up to 30% [4,15,16,[21][22][23]. The current series did not record mortality; however, a relatively high prevalence of postoperative EC was found in the first set of patients (group I, 29%), which may be explained by the cited issues.…”

“…It is therefore conceivable that IND may predispose to postoperative EC because it causes intestinal stasis and is frequently associated with HD. This relationship has been previously suggested to explain general postoperative complications [1][2][3][4][5][6][7][8]32]. Ure et al [5] showed that children with aganglionosis plus IND developed ileus more frequently and needed a second resection more often; a previous study from the same institutions revealed that all the patients who underwent a second resection had another coexistent dysganglionosis [6].…”

“…Despite intensive research, the pathophysiology of this complication has not been fully elucidated; because type B intestinal neuronal dysplasia (IND), a well-established cause of abnormal colonic motility, 0022 is frequently found in the ganglionic pulled-through colon, it seems attractive to implicate coexisting IND in the pathogenesis of postoperative EC [1][2][3][4][5][6][7][8].…”