Is It Safe to Operate without Frozen Section Biopsies in Short-Segment Hirschsprung’s Disease? An Overview of 60 Cases

TL;DR

This study shows that experienced surgeons can accurately determine the resection level in short-segment Hirschsprung’s disease without frozen section biopsies.

Contribution

Demonstrates the reliability of macroscopic intraoperative judgment in resource-limited settings for Hirschsprung’s disease surgery.

Findings

Macroscopic evaluation accurately identified the resection level in short-segment Hirschsprung’s disease.

Microscopic results confirmed that resections were performed in normally ganglionated bowel segments.

Pearson’s correlation showed significant agreement between macroscopic and microscopic assessments.

Abstract

Background: Advancements in surgical management in a single-stage procedure made intraoperative frozen section biopsies critical for determining of level of resection to avoid the potential risk of leaving a retained aganglionic segment. However, in most low-income countries, due to the lack of this facility, the surgeon’s intraoperative judgment is used for the determination of the resection level. Objective: This study aims to evaluate the accuracy of determining the level of bowel resection in short-segment Hirschsprung’s disease based on macroscopic changes. Materials and methods: Intraoperative macroscopic evaluations were assessed using postoperative microscopic findings to determine whether the surgeons’ intraoperative judgments were accurate in determining the level of bowel resection in 60 cases of operated short-segment Hirschsprung’s disease. In addition, Pearson’s correlation coefficient was used to determine whether the sensitivity and specificity of both methods were significantly correlated. Results: The microscopic results showed that the level of resection based on the macroscopic evaluation was performed in normally ganglionated segment in cases of short-segment Hirschsprung’s disease. Conclusions: Macroscopic intraoperative assessment by an experienced surgeon is highly accurate method of determining the level of bowel resection in short-segment HSCR.

Figures