RELIABILITY OF THE LAPAROSCOPIC IDENTIFICATION OF THE LEVEL OF TRANSITIONAL ZONE IN HIRSCHSPRUNG`S DISEASE

Dr. Abdel-Aziz Yehya*, Ibrahim Gamaan, Mohamad Mahfouz and Refaat Ibrahem

ABSTRACT

Background/Aim: It is crucial to exactly identify the level of transition to the normal ganglionic colon in instances of Hirschprung's disease (HD). The correlation between the laparoscopic leveling of the transitional zone (TZ) and frozen section histopathologically based level of aganglionosis has not been well studied. The aim of this study is to assess whether the laparoscopic leveling of TZ could be a reliable method for the diagnosis of the actual level ofaganglionosis of the HD. Patients and Methods: The study included 150 patients’ diagnosedas HD by rectal biopsy. All patients were subject to laparoscopy for identification of TZ. Three laparoscopic seromuscularbiopsies was taken for intra-operative frozen section [IOFS] from thelaparoscopically identified TZ, 2-cm distal and 10-cm proximal to TZ. In cases of non-identification of any TZ, laparoscopic seromuscular biopsies were taken from therectosigmoid, sigmoid, descending colon, splenic flexure and the transverse colon for IOFS. Then, laparoscopic assisted endo-rectal pull through was completed according to the results of IOFS. The results of IOFS were compared with the results of permanent paraffin section Results: The study included 98 males and 52 females with HD. Their mean age was 2.4±12 years (age range = 5 months to 6 years). All operations were completed laparoscopically without conversion. The mean operative time was 54.4±12 minutes (range =45 to 70 minutes). Laparoscopic identification of the TZ coincided with the suspected TZ in the images of preoperative barium enema in 125 patients. While in 25 patients without a detectable TZ in the preoperative barium enema, TZ was identified laparoscopically. Laparoscopic identification of the level of the TZ zone coincided with thehistopathological results of IOFS [IOFS] and permanent paraffin section in all patients. No intraoperative complications were reported. Conclusion: Laparoscopic identification of TZ in patients with HD is a feasible and a safe procedure. It is a reliable method for determining the actual level of aganglionosis in HD.

Keywords: Laparoscopy, Frozen section, Biopsy, Hirschsprung`s disease. Leveling colostomy. Transitional Zone.