Guidelines for synoptic reporting of surgery and pathology in Hirschsprung disease

Laura V Veras¹, Michael Arnold², Jeffrey R Avansino³, Kevin Bove⁴, Robert A Cowles⁵, Megan M Durham⁶, Allan M Goldstein⁷, Chandra Krishnan⁸, Jacob C Langer⁹, Marc Levitt¹⁰, Hector Monforte-Munoz¹¹, Raja Rabah¹², Miguel Reyes-Mugica¹³, Michael D Rollins 2nd¹⁴, Raj P Kapur¹⁵, Ankush Gosain¹⁶; American Pediatric Surgical Association Hirschsprung Disease Interest Group

Affiliations

¹ Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
² Ohio State University, Pathology and Laboratory Medicine, Nationwide Children's, Columbus, OH, USA.
³ University of Washington, Department of Surgery, Division of Pediatric Surgery, Seattle Children's Hospital, Seattle, WA, USA.
⁴ University of Cincinnati, Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁵ Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
⁶ Emory University Department of Surgery, Division of Pediatric Surgery; Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁷ Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Clinical Pathology Associates, Dell Children's Medical Center of Central Texas, Austin, TX, USA.
⁹ Division of Pediatric General and Thoracic Surgery, Hospital for Sick Children, and Department of Surgery, University of Toronto, Toronto, Canada.
¹⁰ Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
¹¹ Anatomic Pathology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
¹² University of Michigan, Department of Pathology, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
¹³ University of Pittsburgh, Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ University of Utah, Department of Surgery, Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, UT, USA.
¹⁵ Department of Laboratories, Seattle Children's Hospital, University of Washington, Seattle, WA, USA. Electronic address: raj.kapur@seattlechildrens.org.
¹⁶ Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA. Electronic address: agosain@uthsc.edu.

PMID: 30935730
PMCID: PMC6754813
DOI: 10.1016/j.jpedsurg.2019.03.010

Review

Guidelines for synoptic reporting of surgery and pathology in Hirschsprung disease

Laura V Veras et al. J Pediatr Surg. 2019 Oct.

. 2019 Oct;54(10):2017-2023.

doi: 10.1016/j.jpedsurg.2019.03.010. Epub 2019 Mar 21.

Authors

Affiliations

¹ Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
² Ohio State University, Pathology and Laboratory Medicine, Nationwide Children's, Columbus, OH, USA.
³ University of Washington, Department of Surgery, Division of Pediatric Surgery, Seattle Children's Hospital, Seattle, WA, USA.
⁴ University of Cincinnati, Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁵ Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
⁶ Emory University Department of Surgery, Division of Pediatric Surgery; Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁷ Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Clinical Pathology Associates, Dell Children's Medical Center of Central Texas, Austin, TX, USA.
⁹ Division of Pediatric General and Thoracic Surgery, Hospital for Sick Children, and Department of Surgery, University of Toronto, Toronto, Canada.
¹⁰ Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
¹¹ Anatomic Pathology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
¹² University of Michigan, Department of Pathology, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
¹³ University of Pittsburgh, Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ University of Utah, Department of Surgery, Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, UT, USA.
¹⁵ Department of Laboratories, Seattle Children's Hospital, University of Washington, Seattle, WA, USA. Electronic address: raj.kapur@seattlechildrens.org.
¹⁶ Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA. Electronic address: agosain@uthsc.edu.

PMID: 30935730
PMCID: PMC6754813
DOI: 10.1016/j.jpedsurg.2019.03.010

Abstract

Background/purpose: Synoptic, or standardized, reporting of surgery and pathology reports has been widely adopted in surgical oncology. Patients with Hirschsprung disease may experience morbidity related to surgical factors or underlying pathology and often undergo multiple operations. Our aim is to improve the postoperative outcome and care of patients with Hirschsprung disease by proposing a standardized set of data that should be included in every surgery and pathology report.

Methods: Members of the American Pediatric Surgical Association Hirschsprung Disease Interest Group and experts in pediatric pathology of Hirschsprung disease participated in group discussions, performed literature review and arrived at expert consensus guidelines for surgery and pathology reporting.

Results: The importance of accurate operative and pathologic reports and the implications of inadequate documentation in patients with Hirschsprung disease are discussed and guidelines for standardizing these reports are provided.

Conclusions: Adherence to the principles of reporting for operations and surgical pathology may improve outcomes for Hirschsprung disease patients and will facilitate identification of correlations among morphology, function, genetics and outcomes, which are required to improve the overall management of these patients.

Level of evidence: V.

Keywords: Aganglionosis; Enteric nervous system; Hirschsprung disease; Pathology; Surgery; Synoptic.

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Figures

**Figure 1.. Recommended operative report addendum for surgical reporting of HSCR.**
The form provides checkboxes for surgical technique, including open versus minimally-invasive approaches, variations on ostomies, specific types of pull-through operations, and details of prior operations if a re-do surgery has been performed. A diagram to annotate locations of biopsies, placement of ostomies, and site of anastomosis is provided. Space is provided for detailing distances that are important to note, such as length of small bowel disease (relative to either the ileocecal valve or ligament of Treitz), anastomosis distance from the dentate line, and the length of muscular cuff (Soave) or retained aganglionic segment (Duhamel).

**Figure 2.. Recommended surgical pathology work-up for pull-through resection specimens.**
Intraoperative frozen section evaluation of the entire circumference of the proximal surgical margin should be performed to exclude histological features of transition zone. An en face section of the margin can be frozen entirely either as a concentric ring (“donut”) or divided into linear sectors (easier to orient with large diameter specimens). The remaining bowel should be opened longitudinally and sampled by some variation of either of the two illustrated methods to include full-circumference samples of the proximal and distal ends, along with either a longitudinal strip or closely spaced (1–2 cm) transverse sections.

See this image and copyright information in PMC

References

1. Commission TJ. The Joint Commission 2018. [Available from: https://www.jointcommission.org/.
1. Cundy TP, Kirby CP, Kirby ML. Synoptic operative reports for quality improvement in pediatric cancer care. Pediatr Blood Cancer. 2018;65(10):e27238. - PubMed
1. Edhemovic I, Temple WJ, de Gara CJ, Stuart GC. The computer synoptic operative report--a leap forward in the science of surgery. Ann Surg Oncol. 2004;11(10):941–7. - PubMed
1. Swenson O My early experience with Hirschsprung's disease.1989. August 839–44- discussion 44–5 p. - PubMed
1. Friedmacher F, Puri P. Rectal suction biopsy for the diagnosis of Hirschsprung’s disease: a systematic review of diagnostic accuracy and complications. Pediatr Surg Int. 2015;31(9):821–30. - PubMed

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Guidelines for synoptic reporting of surgery and pathology in Hirschsprung disease

Affiliations

Guidelines for synoptic reporting of surgery and pathology in Hirschsprung disease

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials