Evaluation Of Intraoperative Frozen Sections (IOFS) In The Operation Of Hirschsprung's Disease

ObjecObjectiveIntraoperative identification of the precise range of aganglionic bowel stillpresented a challenge for the pediatric surgeon in the treatment of Hirschsprung'sdisease (HD), which always depended upon intraoperative frozen sections. Theprimary aim of this study was to evaluate the role of intraoperative frozen sections(IOFS) in surgery for Hirschsprung's disease.MethodsWe collected and analyzed retrospectively clinical data for 22 children whounderwent surgery for HD. During surgery the full-thickness intestinal biopsiesat three levels (narrow segment, transitional zone, and dilated segment) wereperformed and marked by the single-blind method. The results of IOFS andpostoperative paraffin sections were compared.ResultsDiscordance between IOFS and paraffin-section analysis occurred in 3 cases(13.6﹪).1 case(4.5％)was false-positive, which was reported vacuolardegeneration of ganglion cells in IOFS, but was confirmed normal in postoperativeparaffin sections. 2 cases (9.1％) were false-negative, that reported normalganglion cells in the dilated and narrow segments in IOFS, but decreased obviouslyin transitional zone.2 cases (9％) reported that the ganglion cells were decreasedobviously in the resection margin in both IOFS and paraffin sections. For 1 case(4.5％),the decrease of ganglion cells were showed in the narrow and transitionalsegments in IOFS, which was confirmed allied disorders of Hirschsprung disease(HAD). The other 21 were confirmed HD in postoperative paraffin sections. Conclusions(1) IOFS could not act as the diagnostic modality own to the high misdiagnosis.However, it remained an important role in the HD treatment, which was criticalin determining the extent of the involved segment resection.(2) Especilally, IOFS was necessary for the surgical treatment in a relativelyuncommon form of Hirschsprung's disease, such as long-segment HD and total colonicaganglionosis.(3)IOFS help to differentiate HAD from HD in the intraoperative diagnosis,which lead to more reasonable surgical treatment.(4)If the ganglion cells were found vacuolar degeneration, the involved bowelshould be removed, avoiding for reappearance of colonic obstruction syndrome aftersurgical treatment of patients with Hirschsprung's disease.(5)The objectivity of pathological examination could be improved by thesingle-blind randomized marking.