Duhamel operation vs neonatal transanal endorectal pull-through procedure for Hirschsprung disease: which are the changes for pathologists?
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.
Berrebi
Dominique
D
Service d'Anatomie et de Cytologie Pathologiques et EA3102, Hôpital Robert Debré, AP-HP, Paris 75019, France. dominique.berrebi@rdb.ap-hop-paris.fr
Fouquet
Virginie
V
de Lagausie
Pascal
P
Carricaburu
Elisabeth
E
Ferkdadji
Latita
L
Chomette
Pascale
P
Enezian
Goharig
G
Ezzahir
Nadia
N
Peuchmaur
Michel
M
Aigrain
Yves
Y
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