Intra-operative application of ultra-high frequency ultrasound facilitates differentiation of bowel wall characteristics between ganglionic and aganglionic segments during transanal endorectal pull-through for Hirschsprung disease.
Christina Granéli, Maria Evertsson, Tobias Erlöv, Tebin Hawez, Kristine Hagelsteen, Louise Tofft, Tomas Jansson, Magnus Cinthio, Pernilla Stenström
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Abstract
Background: The hypothesis was that ultra-high-frequency (UHF) ultrasound can distinguish ganglionic from aganglionic bowel during surgery for Hirschsprung disease. The aim was to assess UHF ultrasound for differentiating ganglionosis from aganglionosis in children undergoing rectosigmoid Hirschsprung disease surgery.
Methods: The child's intestine was examined intra-operatively using the Vevo MD (Fujifilm VisualSonics, Toronto, ON, Canada) system equipped with the UHF70 transducer; 50 MHz in center frequency. Collected images were analyzed and results presented as median.
Results: Twenty-one patients were examined intra-operatively with UHF ultrasound. The muscularis interna was thicker in ganglionic bowel compared to aganglionic: 0.298 vs 0.599 (p < 0.001), and the ratio of the muscularis interna/muscularis externa was greater; 0.621 vs 1.225 (p < 0.001). The echogenicity was higher, i.e., whiter, in the aganglionic submucosa 104.5 vs 81.6 (p < 0.016).
Conclusion: The use of intra-operative UHF ultrasound shows great promise in the determination of ganglionic versus aganglionic bowel.
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