Proximal Segment Histology of Resected Bowel in Hirschsprung's Disease Predicts Postoperative Bowel Function

Dear Sir,

We registered with great interest, that the article “Proximal segment histology of resected bowel in Hirschsprung's disease predicts postoperative bowel function”, published by Schulten, Holschneider and Meier-Ruge ([2]) confirmed the results of our multicenter study with the similar topic “Hirschsprung's disease and intestinal neuronal dysplasia - a frequent association with implications for the postoperative course” ([1]). The quotas for aganglionosis (4 % vs. 10 %) and neuronal dysplasia (27.7 % vs. 32 %) at the proximal segment were very similar. Hypoganglionosis was seldom seen in the prospective study (2 %) compared with the retrospective evaluation going back to 1979 (25.7 %). Probably the transitional hypoganglionic segment is meanwhile consequently resected.

Schulten et al pointed out the problem of constipation during follow-up in 13.6 % of isolated or IND-associated Hirschsprung cases; we had found that constellation in 20.8 %. As we could show from further biopsies, taken from remaining colon or small bowel, constipation and the need for secondary interventions were accentuated in cases with long segmental or so-called disseminated IND.

We agree with the statement that intraoperative histochemical examination is of outstanding importance and should not be reduced to the question whether ganglion cells are visible or not. This observation would be insufficient to exclude dysganglionic or hypoganglionic segments, responsible for postoperative bowel dysfunction.

References

• 1 Schmittenbecher P P, Sacher P, Cholewa D, Haberlik A, Menardi G, Moczulski J, Rumlova E, Schuppert W, Ure B. Hirschsprung's disease and intestinal neuronal dysplasia - a frequent association with implications for the postoperative course.  Pediatr Surg Int. 1999;  15 553-558
• 2 Schulten D, Holschneider A M, Meier-Ruge W. Proximal segment histology of resected bowel in Hirschsprung's disease predicts postoperative bowel function.  Eur J Pediatr Surg. 2000;  10 378-381