title: Duhamel operation vs neonatal transanal endorectal pull-through procedure for Hirschsprung disease: which are the changes for pathologists?
abstract: BACKGROUND
  The aim of this study was to evaluate whether performing definitive surgery for Hirschsprung disease (HD) in neonatal period with a transanal endorectal pull-through (TEPT) procedure had modified our diagnostic relevance, particularly during intraoperative frozen sections (IOFS), compared to classic Duhamel (DH) surgery performed in older children.
  
  
  METHODS
  We collected pathologic data for 47 children who underwent surgery for neonatal nontotal HD over a 5-year period.
  
  
  RESULTS
  Twenty-nine patients underwent TEPT and 18 the DH operation. Mean age at operation was 19 days for TEPT and 4 months for DH operation. The mean number of IOFS was 2.6 for TEPT and 2.4 for DH operation. Gross examination could be fully completed in all TEPT cases, but was incomplete in 5 DH cases. The average total lengths of bowel, and aganglionic, transitional, and ganglionic segments were 12.3, 7.3, 3, and 2 cm for TEPT, and 17.6, 9.3, 3.5, and 4.8 cm for DH operation, respectively. Discordance between IOFS and paraffin-section analysis occurred in 5 cases (3 TEPT and 2 DH operation).
  
  
  CONCLUSIONS
  When TEPT was used, the gross examination and sampling was more accurate, leading to a clearer pathology report. The TEPT procedure facilitates the work of the pathologist without modifying the results of IOFS, if some precautions are taken.
authors: Service d'Anatomie et de Cytologie Pathologiques et EA3102, Hôpital Robert Debré, AP-HP, Paris 75019, France. dominique.berrebi@rdb.ap-hop-paris.fr
authors: Dominique
authors: D
authors: Berrebi
authors: Virginie
authors: V
authors: Fouquet
authors: Pascal
authors: P
authors: de Lagausie
authors: Elisabeth
authors: E
authors: Carricaburu
authors: Latita
authors: L
authors: Ferkdadji
authors: Pascale
authors: P
authors: Chomette
authors: Goharig
authors: G
authors: Enezian
authors: Nadia
authors: N
authors: Ezzahir
authors: Michel
authors: M
authors: Peuchmaur
authors: Yves
authors: Y
authors: Aigrain
mesh_terms: D003106:Colon / Q000473:pathology; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male