Laparoscopy-assisted transanal pull-through at the time of suction rectal biopsy: a new approach to treating selected cases of Hirschsprung disease.
OBJECTIVE
We present a new approach to treating selected cases of Hirschsprung disease (HD) where suction rectal biopsy (SRBx) is performed in an operating room, and rapid acetylcholinesterase staining (RAST) is used to identify histopathology within 20 minutes, allowing primary laparoscopy-assisted transanal pull-through (PLTPT) to be commenced "immediately" (n = 7).


METHODS
All subjects had an obvious caliber change in the rectum/sigmoid colon on barium enema and were strongly suspected of having HD.


RESULTS
Rapid acetylcholinesterase staining clearly demonstrated acetylcholinesterase-positive hypertrophic nerve trunks and absence of ganglion cells in all SRBx specimens, indicating that all 7 patients had HD. All 7 proceeded to uneventful PLTPT. By taking this approach, SRBx results were available extremely quickly, and hospital stay was reduced by 2 to 4 days.


CONCLUSIONS
Our approach enhanced the treatment of selected cases of HD by proceeding immediately to PLTPT after SRBx specimens were examined using RAST.
Yamataka
Atsuyuki
A
Department of Pediatric Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan. yama@med.juntendo.ac.jp
Kobayashi
Hiroyuki
H
Hirai
Shu
S
Koga
Hiroyuki
H
Miyano
Go
G
Lane
Geoffrey J
GJ
Okazaki
Tadaharu
T
D000110:Acetylcholinesterase; D001706:Biopsy; D003082:Colectomy; D006627:Hirschsprung Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D012007:Rectum / Q000473:pathology*; D013194:Staining and Labeling
D000110:Acetylcholinesterase