Is it safe to operate without frozen section biopsy in short segment Hirschsprung’s disease, an overview of 60 cases

Abstract

Background - Advancment in surgical menagement in a single-stage procedure made intraoperative frozen section biopsy critical for determinin of level of resection to avoid the potential risk of leaving a retained aganglionic segment. However, in most low-income countries due to te lack of this facility, surgeon’s intraoperative judgement is used for the determination of resection level. Objective - This study aims to evaluate the accuracy of determining the level of bowel resection in short segment HSCR based on macroscopic changes by identifying transition zone as sudden increase in the width typically marked proximal to aganglionated with progressive dilatation in normoganglionated segemnt. Material and methods -Intraoperative macroscopic evaluation was assessed with postoperative microscopic findings to determine whether the Surgeons intraoperative judgement was accurate in determining the level of bowel resection in 60 cases operated from short segment HSCR. In addition, Pearson's correlation coefficient was used to determine if the sensitivity and specificity of both methods were significantly correlated. Results - Microscopic results showed that the level of resection based on macroscopic evaluation was performed in normally ganglionated segment. Findings confirmed perfect concordance between microscopic and macroscopic evaluation in predicting the level of resection (Kappa=1). The sensitivity and specificity of macroscopic and microscopic examinations showed perfect positive correlation also (Pearson's correlation coefficient r = 1.0). Conclusion - Macroscopic intraoperative assessment by experienced surgeon is highly accurate method in deteminin the level of bowel resection in short segment HSCR.