Prediction of the outcome of pull-through surgery for Hirschsprung's disease using acetylcholinesterase activity

Background and Purpose: Advances in surgical procedures for the treatment of Hirschsprung's disease have afforded the majority of patients a satisfactory outcome after definitive corrective surgery. However, some patients continue to have signs of persistent bowel dysfunction despite adequate resection of the aganglionic bowel segment. The definite etiology of persistent bowel dysfunction in these patients remains controversial. Materials and Methods: The acetylcholinesterase activity in the proximal resection margin of pull-through surgical specimens collected froth September 1992 to June 1998 was evaluated and correlated with clinical outcome. Results: A total of 24 patients were studied, 15 males and 9 females. The follow-tip period ranged front 1 year 7 months to 7 years 6 months. The Soave procedure was performed in 17 cases and the Duhamel in 7. Twenty cases had a good or fair clinical outcome and four (16.7%) had a poor outcome. There was no mortality. Among the 20 patients with a good or fair outcome, the acetylcholinesterase activity in the proximal section margins was not increased in 12, mildly increased in seven, and moderately increased in one. The four cases with poor outcome all had moderately increased acetylcholinesterase activity in at least one specimen. The association between moderately increased acetylcholinesterase activity and poor surgical outcome was significant (p = 0.0005). In contrast, there was no association between the surgical method (Soave or Duhamel) used and clinical outcome (p= 0.55). Conclusion: Acetylcholinesterase activity in the proximal resection margins of pull-through surgical specimens is a useful indicator for predicting the postoperative outcome in Hirschsprung's disease.