title: Hirschsprung's disease: the "Swiss roll" technique revisited.
abstract: OBJECTIVE
  During pull-through for Hirschsprung's disease (HSCR), the assessment of innervation is mainly based on the presence of ganglion cells when conventional Hematoxylin and Eosin (HE) staining is used. In hypoganglionosis, the evaluation is difficult. We adapted a standardized methodology for the examination of resected bowel after HSCR surgery, using the technique described by Moolenbeek on rodent intestine and later by Meier-Ruge in children. We have analysed the entire innervation of surgically resected bowels and compared the results with the follow up of patients.
  
  
  METHODS
  Three longitudinal strips of colon were harvested from the mesenteric, anti-mesenteric and intermediate part in the whole length of resected colon of six patients with HSCR. Each strip was divided into two parts. One of the contiguous strips was assessed with HE and Hematoxylin-Phloxin-Safran, and the other one with acetylcholinesterase (AChE) histochemistry. We analyzed the distribution of ganglion cells and nerve arrangement along the strips with both techniques and compared the results obtained in the three different regions of the bowel.
  
  
  RESULTS
  There was no significant difference in the pattern of innervation circumferentially. There was a correlation between a progressive increase of AChE activity and nerve hypertrophy and a decrease of ganglion cells from the proximal to the distal part of the resected colon in the submucosa and the myenteric plexus. Nerve hypertrophy and AChE-positive reaction in the mucosa were found at the resection border in patients who presented postoperative complications.
  
  
  CONCLUSIONS
  Simultaneous assessment of nerve cells, nerve fibers and AChE activity is important in the evaluation of the innervation of the bowel segment proximal to the aganglionic zone. The method described is feasible and can be adapted to older children and adults with larger bowels. These results point out the importance of assessing nerve fibers in intraoperative biopsies during pull-through procedures to prevent uncomplete surgical bowel resection.
authors.affiliation: Department of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne 1011, Switzerland.
authors.forename: Maria-Chiara
authors.initials: MC
authors.lastname: Osterheld
authors.forename: Kathleen
authors.initials: K
authors.lastname: Meagher-Villemure
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Ciola
authors.forename: Patricia
authors.initials: P
authors.lastname: Martin
authors.forename: Daniel
authors.initials: D
authors.lastname: Vilas
authors.forename: Blaise Julien
authors.initials: BJ
authors.lastname: Meyrat
mesh_terms: D000110:Acetylcholinesterase / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000166:cytology / Q000294:innervation* / Q000473:pathology; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007223:Infant
chemical_list: D000110:Acetylcholinesterase