Advantages of intraoperative semiquantitative evaluation of myenteric nervous plexuses in patients with Hirschsprung disease.
BACKGROUND
The reappearance of an occlusive syndrome after surgical treatment of patients with Hirschsprung disease is often caused by incomplete resection of the affected segment. Intraoperative examination of frozen biopsies assists surgery, but interpretation of biopsies in the transitional zone is difficult.


METHODS
We performed retrospective semiquantitative evaluations of myenteric nervous plexuses at the proximal limits of resection specimens from 41 children who were treated for rectocolic Hirschsprung disease using intraoperative examination of transparietal biopsies. The results of the evaluations were correlated with the postoperative courses of the children.


RESULTS
After formalin fixation, the mean length of the aganglionic segments was 8.9 cm (range, 1-37.5 cm). At the proximal limit, the percentage of the circumference of the muscularis propria that was composed of plexuses with ganglion cells was more than 95% in 7 children, 90% to 95% in 21 children, 40% to 80% in 6 children, and 30% or less in 7 children (17%), 4 of whom subsequently developed occlusive syndromes.


CONCLUSIONS
Semiquantitative intraoperative examination of the entire circumference of resected segments facilitates precise evaluation of intrinsic innervation at the level of the anastomosis and may reduce the frequency of recurrence of occlusive symptoms after surgery.
Boman
Françoise
F
Department of Pathology, University Hospital of Lille, 59037 Lille, France. f-boman@chru-lille.fr
Sfeir
Rony
R
Priso
René
R
Bonnevalle
Michel
M
Besson
Rémi
R
D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000294:innervation*; D015897:Comorbidity; D005260:Female; D005629:Frozen Sections; D006627:Hirschsprung Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D009197:Myenteric Plexus / Q000473:pathology*; D009474:Neurons / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012007:Rectum / Q000294:innervation*; D012189:Retrospective Studies; D055502:Secondary Prevention