Hemanshoo S Thakkar1, Simon Blackburn1, Joe Curry1, Paolo De Coppi1, Stefano Giuliani1, Neil Sebire2, Kate Cross3. 1. Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK. 2. Paediatric & Developmental Pathology, UCL Institute of Child Health, Great Ormond Street Hospital, London, UK. 3. Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK. Electronic address: kate.cross@gosh.nhs.uk.
Abstract
BACKGROUND: Surgical management of Hirschsprung disease (HD) involves fully excising the transition zone (TZ). The literature suggests that resection of ≥5 cm of ganglionic bowel proximal to the aganglionic segment is sufficient. Our primary aim was to evaluate the lengths of the TZ in a cohort of consecutive patients with HD. We reviewed the impact this had on the need for revision surgery. We hypothesized that the TZ can be highly variable and may lead to a TZ pull-through when the proximal donut is not reviewed intraoperatively. METHODS: A retrospective review was conducted for all patients undergoing primary pull-through surgery between January 2012 and September 2018. Data was collected on demographics, need for staged surgery, and complications following surgery. RESULTS: Forty-eight patients were eligible for inclusion. 11/48 (23%) patients presented late (>6 months). 27/48 (56%) patients needed a stoma prior to definitive surgery. The median age at pull-through was 6 months (1-84 months). The median TZ length was 1.7 cm (0.3-22.9 cm). 11/48 (23%) had a TZ >5 cm. 36/48 (75%) patients did not have intraoperative review of the donut resulting in three TZ pull-throughs. CONCLUSIONS: We would advocate circumferential intraoperative frozen section review of the proximal donut to minimize the risk of a TZ pull-through. LEVEL OF EVIDENCE: Level III.
BACKGROUND: Surgical management of Hirschsprung disease (HD) involves fully excising the transition zone (TZ). The literature suggests that resection of ≥5 cm of ganglionic bowel proximal to the aganglionic segment is sufficient. Our primary aim was to evaluate the lengths of the TZ in a cohort of consecutive patients with HD. We reviewed the impact this had on the need for revision surgery. We hypothesized that the TZ can be highly variable and may lead to a TZ pull-through when the proximal donut is not reviewed intraoperatively. METHODS: A retrospective review was conducted for all patients undergoing primary pull-through surgery between January 2012 and September 2018. Data was collected on demographics, need for staged surgery, and complications following surgery. RESULTS: Forty-eight patients were eligible for inclusion. 11/48 (23%) patients presented late (>6 months). 27/48 (56%) patients needed a stoma prior to definitive surgery. The median age at pull-through was 6 months (1-84 months). The median TZ length was 1.7 cm (0.3-22.9 cm). 11/48 (23%) had a TZ >5 cm. 36/48 (75%) patients did not have intraoperative review of the donut resulting in three TZ pull-throughs. CONCLUSIONS: We would advocate circumferential intraoperative frozen section review of the proximal donut to minimize the risk of a TZ pull-through. LEVEL OF EVIDENCE: Level III.
Authors: Christian Tomuschat; Stefan Mietzsch; Sebastian Dwertmann-Rico; Till Clauditz; Hansjoerg Schaefer; Konrad Reinshagen Journal: Children (Basel) Date: 2022-01-25
Authors: Wendy Yang; Jenny Pham; Sebastian K King; Donald F Newgreen; Heather M Young; Lincon A Stamp; Marlene M Hao Journal: Biomolecules Date: 2022-08-10