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).