How accurate are our eyes in the localization of the transition zone in Hirschsprung's disease? [Oral presentation]

Abstract

<p><b>Purpose: </b>To determine the correlations among radiological, visualized and pathological transition zones (TZs) in patients with Hirschsprung’s disease (HD). </p><p><b>Method: </b>All patients with HD who had endorectal pullthrough operation in our center in the past two decades were reviewed. Background demographics and clinical parameters like gestational age, timing and symptoms of presentation, comorbidities, type of pull through, age at operation etc. were included. In particular, the TZs determined radiologically on contrast enema, visually from intra-operative findings and pathologically under microscopic examination were compared and analyzed using IBM SPSS 26. Numerical values were expressed as medians (interquartile range, IQR) and percentages. </p><p><b>Results: </b>Sixty-eight patients with HD and endorectal pullthrough operation in our center were identified in the 20-year period. The median age at presentation was 2 days (IQR 1-5 days, range 1 day - 9 years). The most common initial presenting symptom was neonatal intestinal obstruction (57.8%), followed by delayed passage of meconium (23.4%). A stoma was required in 29.2% of patients. A contrast enema was arranged in 85.9% of the cohort. 97.8% of those who had a 24-hour delayed abdominal xray after contrast enema demonstrated retained contrast. The correlation between radiological and pathological transition zones was 50.9%, and that between visualized and pathological transition zones was 62.5%. The strength of correlation weakens in long segment disease when compared to short segment disease (58.3% versus 63.5%). </p><p><b>Conclusion:</b> <span>The accuracy of pre-operative (radiological) and intra-operative (visualized) prediction of the TZ in HD are 50% and 60% respectively. Although they provide a road map for surgical planning and optimal site of colonic biopsies, frozen section of intra-operative colonic biopsies remains the most reliable method for precise identification of the level of ganglionic bowel for pullthrough. </span></p>