Results
This study includes 24 patients that 14 (58%) were female, and 10 (48%) were male. In terms of age, 15 (62.5%) of 24 patients were newborns (0-28 days), and 9 (37.5%) were children between 1 month and 36 months. Meconium output was not observed in 16 (66.7%) patients at the first 24 hours. 10 (62.5%) of these 16 patients were diagnosed with HD after further examinations and evaluations. RSI was calculated as <1 in 7 (29.1%) patients and ≥1 in 9 (37.5%) patients. Adequate radiography could not obtain or evaluated due to the presence of previous ileostomy or colostomy in 8 (33.3%) of the patients. Seven (29.1%) patients with RSI less than one were diagnosed HD after subsequent examinations.
During the study, none of the patients developed rectal bleeding, intestinal perforation, sepsis or similar complications after SRB at the diagnosis stage.
No ganglion cells were found in the samples of 10 (41.6%) patients in the pathological evaluation and diagnosed as HD. Ganglion cells were observed in the pathological examination of the samples in 5 (20.8%) of the patients, and HD was excluded. Biopsy samples of 9 (37.5%) patients were evaluated and reported as insufficient or suspicious samples for the pathological examination.
FTRB was obtained from 4 (16.6%) patients who were evaluated as inadequate and suspicious SRB, and HD diagnosis was excluded in these patients due to the presence of ganglion cells in the pathological examination of the samples. The other 5 (20.8%) patients with insufficient results were discharged after their complaints regressed, and due to the symptoms were regressed by follow-up, we excluded the diagnosis of HD. Afterwards, patients were taken periodic follow-up for six months by outpatient clinic controls. During the follow-up period, no findings suggestive of HD were detected, and their families were informed and excluded from the follow-up. In addition, all patients were followed up with outpatient clinic controls after discharge for at least six months. From the SRB results obtained from 24 patients, the volume of the biopsy, the submucosa (SM) / mucosa (M) ratio and the percentage of SM tissue in the preparation (SM%) were calculated. The results were summarized in table 1.
When we compared the preoperative SRB materials and postoperative resection materials, 10 (41.6%) patients with preoperative ganglion negative SRB results showed aganglionosis in postoperative resection materials. In the pathological evaluation of samples in 5 (20.8%) patients, the presence of a ganglion cell in SRB was reported. According to these results of 5 patients; due to the disappearance of symptoms in favour of HD in clinical observation, after 6 months of outpatient clinic follow-up, their families were informed, and they were excluded from the follow-up.
When Receiver Operating Characteristic (ROC) analysis was performed to compare SRB samples with pathology results and clinical examination results, it was calculated that if the biopsy volume was greater than 4 mm3, it had 80% sensitivity and 66.67% specificity in the diagnosis of HD (AUC = 0.789); if the SM/M ratio is greater than 0.75 or the SM is greater than 0.42, it has been found that it has 86.67% sensitivity and 66.67% specificity (AUC = 0.748, AUC = 0.752, respectively) (Table 2).
When the results of SRB were evaluated, samples of 15 (62.5%) patients were sufficient, and 9 (37.5%) patients were insufficient or suspicious. The mean volume of adequate biopsies was 8.4 mm3, SM / M ratio 1.22, SM% 0.52, respectively. The mean volume of inadequate biopsies was 4.7 mm3, SM / M ratio 0.77, SM% 0.40, respectively. In terms of SM% of patients, the difference between groups was statistically significant (p: 0.033) (Table 3).
When we evaluate the adequacy of the SRBs in newborn and children between one month and three years old; We calculated the SRB adequacy rate as 73.3% in newborns and 44.4% in children aged between one month and three years (Table 4).