Does transitional zone pull-through in Hirschsprung's disease imply a poor prognosis?

PURPOSE: Accurate frozen section interpretation of intraoperative biopsies is critical to the success of the Duhamel procedure. Errors during sampling or interpretation may result in an abnormal pull-through. The authors' aim was to determine the incidence and outcome of transitional zone pull-through (TZPT).

METHODS

Ninety-six children who underwent a Duhamel procedure between January 1987 and May 2002 were followed up prospectively. The outcome of 18 children with TZPT was compared statistically with that of a cohort of 58 patients with a ganglionic pull-through.

RESULTS

The incidence of TZPT was 18.8%. Concordance rate between frozen and paraffin-section analyses was 88.5%. The incidence of enterocolitis (P =.003) and intractable constipation (P =.02) was found to be significantly higher in TZPT. There was no significant difference in continence (P =.34), rectal sensation (P =.35), and control (P =.53). Five (27.8%) TZPT patients required a revisional surgery for failure of conservative management. The incidence of stoma placement and revision was significantly less in the ganglionic group (3.4%, P =.007).

CONCLUSIONS

Up to one third of patients with TZPT will require revisional surgery for intractable symptoms. Vigilance is warranted in view of the greater risk of enterocolitis. Continence is not significantly affected.