Laparoscopy-assisted transanal pull-through at the time of suction rectal biopsy: a new approach to treating selected cases of Hirschsprung disease

• Published in: Journal of Pediatric Surgery Vol. 41; no. 12; pp. 2052 - 2055
• Main Authors: Yamataka, Atsuyuki, Kobayashi, Hiroyuki, Hirai, Shu, Koga, Hiroyuki, Miyano, Go, Lane, Geoffrey J., Okazaki, Tadaharu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2006; Elsevier BV
• Subjects: Acetylcholinesterase; Biopsy; Colectomy; Hirschsprung Disease; Hirschsprung Disease - pathology; Hirschsprung Disease - surgery; Humans; Infant; Infant, Newborn; Laparoscopy; Rectum; Rectum - pathology; Staining and Labeling; Hirschsprung disease; Laparoscopy-assisted transanal pull-through; Rapid acetylcholinesterase staining
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2006.08.036

We present a new approach to treating selected cases of Hirschsprung disease (HD) where suction rectal biopsy (SRBx) is performed in an operating room, and rapid acetylcholinesterase staining (RAST) is used to identify histopathology within 20 minutes, allowing primary laparoscopy-assisted transanal pull-through (PLTPT) to be commenced “immediately” (n = 7). All subjects had an obvious caliber change in the rectum/sigmoid colon on barium enema and were strongly suspected of having HD. Rapid acetylcholinesterase staining clearly demonstrated acetylcholinesterase-positive hypertrophic nerve trunks and absence of ganglion cells in all SRBx specimens, indicating that all 7 patients had HD. All 7 proceeded to uneventful PLTPT. By taking this approach, SRBx results were available extremely quickly, and hospital stay was reduced by 2 to 4 days. Our approach enhanced the treatment of selected cases of HD by proceeding immediately to PLTPT after SRBx specimens were examined using RAST.