Reoperation for XXXX : pathology of the resected problematic distal pull-through.

@entity1 @entity1964 @entity1963 @entity4494 @entity1412 @entity1142
@entity1963 , which consists of @entity1963 of the rectum and sometimes more proximal bowel, requires surgical removal of the aganglionic bowel and creation of ganglionated neorectum using proximal normally innervated bowel. The border between aganglionic and ganglionic bowel is irregular; the transition zone features variable quantities of @entity4494 cells and numerous large nerves. We report the histopathology of pull-through bowel segments resected because of poor postoperative outcome from 30 @entity1 (22 @entity1 , 8 @entity1 ). The most common indication for reoperation was severe @entity1142 /obstruction. Transition zone (bowel with at least two nerves >= 40   m diameter per 400  high-power field, and @entity4494 cells) or aganglionic bowel (bowel with at least two nerves >= 40   m per high-power field diameter, but without @entity4494 cells) was found in 19/30 (63%) resections. In colons resected because of @entity1412 , rare high-power fields showed two enlarged nerves; the mean age of those @entity1 (135    49.4 months) was significantly higher than that of the @entity1 undergoing redo pull-through surgery (67.9    42.8 months). Additional pathology included @entity1964 . Although there are multiple causes for poor outcomes following surgical therapy for @entity1963 , abnormal innervation of the bowel used for pull-through is common. We recommend that intraoperative consultation at primary pull-through procedure include frozen section evaluation of the circumference of the bowel to be used for pull-through to confirm histologically the presence of both @entity4494 cells and normal-caliber nerves. The criteria used in this study are most suitable for @entity1 and young @entity1 .
