title: Laparoscopy-assisted suction colonic biopsy and intraoperative rapid acetylcholinesterase staining during transanal pull-through for Hirschsprung's disease.
abstract: 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.
authors.affiliation: Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Ryuji
authors.initials: R
authors.lastname: Yoshida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Kanako
authors.initials: K
authors.lastname: Tsukamoto
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Osamu
authors.initials: O
authors.lastname: Segawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Kameoka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyano
mesh_terms: 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
chemical_list: D000110:Acetylcholinesterase