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Surgical acquired aganglionosis: myth or reality?
[hirschsprung disease]
A
number
of
patients
operated
on
for
Hirschsprung
disease
continue
to
have
constipation
and
abdominal
distension
for
years
after
surgery
.
Some
authors
have
proposed
that
ischemia
during
surgery
may
induce
secondary
aganglionosis
.
The
aim
of
the
present
study
was
to
study
the
effects
of
ischemia
on
the
enteric
nervous
system
of
sigmoid
colon
in
an
animal
model
.
A
surgical
model
of
colonic
ischemia
was
created
.
34
adult
Sprague-
Dawley
rats
underwent
a
laparotomy
where
the
marginal
arterioles
of
the
sigmoid
colon
were
ligated
.
After
that
,
a
section
in
the
middle
segment
of
the
sigmoid
colon
was
performed
followed
by
an
anastomosis
.
The
presence
of
ischemia
was
assessed
by
measurement
of
visible
light
spectroscopy
tissue
oximetry
and
histological
examination
.
Colonic
function
was
assessed
by
evaluation
of
stool
weight
.
Rats
were
killed
at
1
,
8
and
12
weeks
after
the
operation
.
12
rats
were
sham-operated
.
Enteric
nervous
system
was
evaluated
by
means
of
immunohistochemistry
with
NGFR
p
75
.
Quantitative
analysis
of
the
number
of
ganglia
and
ganglion
cells
in
the
myenteric
plexus
was
performed
.
The
surgical
model
of
colonic
ischemia
significantly
decreased
tissue
oxygenation
(
pre-surgical
=
54
.
69
±
7
.
32
%
;
post-surgical
=
27
.
37
±
9
.
2
%
;
p
<
0
.
001
)
.
There
was
no
disturbance
in
body-weight
gaining
in
experimental
groups
and
daily
stool
output
did
not
vary
after
surgery
(
pre-surgical
=
4
.
24
±
0
.
94
g
;
post-surgical
=
3
.
82
±
1
g
;
p
=
0
.
09
)
.
All
experimental
groups
showed
persistent
ganglia
.
However
,
there
was
a
significant
decrease
in
the
number
of
ganglia
in
all
the
experimental
groups
compared
to
control
(
1
w
:
45
.
91
±
7
.
66
;
8
w
:
44
.
17
±
10
.
56
;
12
w
:
36
.
17
±
15
.
06
vs
control
:
56
.
88
±
8
.
66
;
p
<
0
.
01
)
.
The
number
of
total
ganglion
cells
was
significantly
reduced
only
in
the
experimental
group
killed
at
week
12
compared
to
control
(
1
w
:
539
±
167
.
58
;
8
w
:
488
.
58
±
154
.
41
;
12
w
:
343
.
94
±
161
.
91
vs
control
:
513
.
96
±
126
.
97
;
p
<
0
.
01
)
.
The
rate
of
ganglion
cells
per
ganglia
was
significantly
higher
in
the
groups
killed
at
week
1
and
8
versus
control
group
(
1
w
:
11
.
63
±
2
.
53
;
8
w
:
11
.
11
±
2
.
56
;
12
w
:
9
.
34
±
1
.
16
vs
control
:
9
.
02
±
1
.
81
;
p
<
0
.
05
)
.
Long
-term
follow-up
after
surgically
induced
colonic
ischemia
in
the
rat
showed
a
decreased
number
of
ganglion
cells
and
ganglia
.
Nevertheless
,
it
did
not
produce
aganglionosis
.
