Laparoscopy-assisted suction colonic biopsy and intraoperative rapid acetylcholinesterase staining during transanal pull-through for Hirschsprung's disease.
BACKGROUND
It is crucial to identify the exact level of transition to normal ganglion cells in instances of Hirschprung's disease. This report describes a technique for laparoscopy-assisted suction colonic biopsy during transanal pull-through.


METHODS
Laparoscopy-assisted suction colonic biopsy (SCBx) was used in 12 patients with Hirschsprung's disease affecting the rectosigmoid. Average age was 4.4 +/- 2.1 months with a mean operative weight 6.2 +/- 1.0 kg. The pull-through was performed as the primary operative procedure in 11 patients. Using a 2-team approach (laparoscopic team and transanal team), the site was chosen for transanal suction biopsy and marked externally by the laparoscopic team with a silver clip. Biopsies were processed for ganglion cells and rapid AChE technique.


RESULTS
There were no biopsy-induced perforations. Abnormal biopsies were repeated more proximally until ganglion cells were observed. Transanal pull-through was performed and an open full-thickness biopsy performed to confirm the presence of ganglion cells. All procedures were performed successfully.


CONCLUSIONS
Laparoscopy-assisted SCBx can be used successfully in patients with Hirschsprung's disease affecting the rectosigmoid (80% of cases). The technique, when used with rapid AChE staining, provides accurate identification of the level of normoganglionosis.
Yamataka
Atsuyuki
A
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Yoshida
Ryuji
R
Kobayashi
Hiroyuki
H
Tsukamoto
Kanako
K
Lane
Geoffrey J
GJ
Segawa
Osamu
O
Kameoka
Shingo
S
Miyano
Takeshi
T
D000110:Acetylcholinesterase / Q000032:analysis*; D001706:Biopsy / Q000379:methods; D003106:Colon / Q000201:enzymology / Q000473:pathology*; D006627:Hirschsprung Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D016343:Monitoring, Intraoperative; D013396:Suction / Q000379:methods
D000110:Acetylcholinesterase