Transition zone pull‐through in Hirschsprung's disease: a tertiary hospital experience

Abstract

The length of the transition zone in children with transition zone pull-through was significantly longer. Though our children with transition zone pull-through did not require redo surgery the possibility of redo surgery remains. Transition zone pull-through should still be considered an error and should be prevented.

Variability of the transition zone length in Hirschsprung disease

“…The incidence of TZ pull-through has been reported in the literature to be between 14-18% [5]. In a recently published series from New South Wales, Australia, the authors report their incidence of TZ pull-through to be 16% [5]. In two of their patients, ganglion cells were not present in the entire circumference of the proximal margin.…”

“…TZ pull-through has been cited as an important etiological factor in persistent post-operative obstructive symptoms as well as enterocolitis [2]. The incidence of TZ pull-through has been reported in the literature to be between 14-18% [5]. In a recently published series from New South Wales, Australia, the authors report their incidence of TZ pull-through to be 16% [5].…”

“…In our series, the median length of the TZ was 2.0 cm, however nearly a quarter of patients in our series had a length of N5 cm with a maximum of 22.9 cm. In view of the literature, general recommendations are to conduct the pull-through between at least 2-5 cm proximal to the distal most ganglionic biopsy [5]. However, when taking into account TZ lengths much greater than 5 cm, this idiom alone may not prevent a TZ pullthrough.…”

“…Boman et al [9] have further conducted a semi-quantitative evaluation of the myenteric plexus at the proximal resection margin and identified significant variability in the percentage of the circumference of the muscularis propria that contained plexuses (30% -95%). The authors of the Australian series [5] as well as Boman et al [9] have both changed their institutional practice to integrate this into their practice. Within our institution, only a quarter of the cohort had frozen section review of the proximal donut.…”

Pullthrough Operation for Hirschsprung's Disease: Importance of a Circumferential (Donut) Biopsy at the Level of the Anastomosis

“…1 Some authors also recommend the presence of ganglion cells and the absence of hypertrophies nerves on a full-thickness biopsy to be adequate to determine the level of pullthrough. 2 Herein, we describe a child in whom this practice would have failed because of the selective absence of ganglion cells in 30% of the circumference of the bowel along the mesenteric border for most of the transverse colon. To the best of our knowledge, this is the first report of such an occurrence and has significant diagnostic and therapeutic implications.…”