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Surgery on Children

Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

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Original Article
Variability of histologic pattern and transition zone length in Hirschsprung disease and associated factors
Abstract
Aims: Transition zone pull-through is a major cause of postoperative obstructive symptoms in Hirschsprung disease. This study aimed to describe the variability of histologic characteristics and transition zone length in Hirschsprung disease and to analyze their association with disease classification, age, and presence of stoma.
Methods: A retrospective histopathologic slide review was performed on hematoxylin–eosin–stained specimens from patients with Hirschsprung disease who had undergone pull-through surgery. Samples were classified into complete transition zone and incomplete transition zone groups based on resection margins. Nerve fiber diameter, interganglionic interval, and transition zone length in the submucosal and intermuscular layers were measured. Associations with disease classification, age, and presence of stoma were analyzed statistically.
Results: The length of the complete transition zone ranged from 2 to 16 cm, whereas the incomplete transition zone ranged from 3 to 33 cm. Overall, no significant associations were found between nerve fiber diameter, interganglionic interval, or transition zone length with disease classification, age, or presence of stoma. However, in the incomplete transition zone group, nerve fiber diameter in the intermuscular layer was significantly associated with age (p = 0.004) and presence of stoma (p = 0.001). Additionally, transition zone length in the submucosal layer was significantly associated with presence of stoma (p = 0.016).
Conclusion: Transition zone length in Hirschsprung disease varies widely and tends to be longer in long segment Hirschsprung disease, increasing age, and in patients with stoma. Adequate proximal resection and intraoperative confirmation of ganglionated bowel are essential to minimize the risk of transition zone pull-through and postoperative obstruction.

Keywords : Hirschsprung disease, histologic pattern, transition zone

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Ethical Statement

Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine, Universitas Indonesia (Date: 05.04.2021, Decision No: KET-316/UN2.F1/ETIK/PPM.00.02/2021).

Informed Consent

This retrospective study used pre-existing anonymized patient data. No additional intervention was performed, and there was no direct patient contact. The study was approved by the Ethics Committee, and the requirement for written informed consent was waived by the ethics committee.

Author Contributions

Concept: RPT; Design: RPT; Control: RPT, NK; Resources: RPT, NK; Materials: RPT, NK; Data Collection and/or Processing: RPT, NK; Analysis and/or Interpretation: RPT, NK; Literature Review: NK; Writing the Article: RPT, NK; Critical Review: RPT, NK.

Conflict of Interest

The authors declare no conflicts of interest related to this study.

Financial Disclosure

The authors received no financial support for the conduct or publication of this research.


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Article available in :
Volume 3, Issue 4, 2026
Page : 113-120
https://doi.org/10.51271/SOC-0083
Article Information
Received : 09 Mar 2026
Accepted : 19 May 2026
Published : 20 Eki 2026
Corresponding Author :

Riana Pauline Tamba: Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

[email protected]
Citation : Tamba RP, Kurnia N. Variability of histologic pattern and transition zone length in Hirschsprung disease and associated factors. Surg Child. 2026;3(4):113-120. doi:10.51271/SOC-0083

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