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

Abstract

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.