title: Transition zone pull-through in Hirschsprung's disease: a tertiary hospital experience.
abstract: BACKGROUND
  Pull-through of ganglionic bowel is essential for successful treatment of Hirschsprung's disease. We studied the incidence of transition zone pull-through in our institution and compared its outcome with ganglionic bowel pull-through.
  
  
  METHODS
  Children who underwent Soave's pull-through for Hirschsprung's disease from January 2005 to November 2012 were studied. Patients were divided into two groups: ganglionic bowel pull-throughs (Group 1) and transition zone pull-throughs (Group 2). Demographics, presentations, surgical procedure, post-operative results and complications including redo procedures were recorded and reviewed along with histopathology reports.
  
  
  RESULTS
  Fifty patients underwent Soave's pull-through for Hirschsprung's disease in our group. The median age at surgery was 13.5 days in Group 1 and 22.5 days in Group 2. Transition zone pull-through occurred in eight children (16%). Transition zone pull-through was attributed to errors in histologic interpretation (n = 5), sampling (n = 2) and surgical technique (n = 1). The transition zone was significantly longer in Group 2 (P = 0.002). Constipation and enterocolitis were the main complications needing therapy. One child in Group 2 required surgery for adhesive intestinal obstruction.
  
  
  CONCLUSIONS
  The length of the transition zone in children with transition zone pull-through was significantly longer. Though our children with transition zone pull-through did not require redo surgery the possibility of redo surgery remains. Transition zone pull-through should still be considered an error and should be prevented.
authors: Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors: Dhruva N
authors: DN
authors: Ghosh
authors: Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors: Yingrui
authors: Y
authors: Liu
authors: Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors: Daniel T
authors: DT
authors: Cass
authors: Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors: Soundappan S V
authors: SSV
authors: Soundappan
mesh_terms: D003248:Constipation / Q000453:epidemiology / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004760:Enterocolitis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology; D012007:Rectum / Q000294:innervation / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Hirschsprung's disease; constipation; enterocolitis; transition zone