Evaluating single incision laparoscopy-assisted extracorporeal biopsy as an alternative to frozen sections in the management of Hirschsprung disease

Hirschsprung disease (HD) is a congenital condition characterized by the absence of ganglion cells in the distal intestine, leading to bowel obstruction. While the use of frozen sections during biopsy is common practice, discrepancies with immunohistochemistry results and the unavailability of frozen section technology in certain pediatric surgical facilities in Indonesia highlight the need for alternative diagnostic approaches. This study evaluates the effectiveness of Single Incision Laparoscopy-Assisted Extracorporeal (SI-ECo) leveling biopsy with immunohistochemistry as a reliable alternative to frozen sections in the preoperative management of Hirschsprung disease, especially in facilities lacking frozen section capabilities. We present three cases of pediatric patients diagnosed with HD confirmed through rectal biopsy. Each patient underwent an SI-ECo leveling biopsy, successfully identifying the ganglionic zone by locating ganglion cells in the distal sigmoid. Based on these findings, subsequent transanal endorectal pull-through (TEPT) procedures were performed. The results demonstrated that SI-ECo leveling biopsy effectively identifies the ganglionic zone, providing a less invasive and precise method for preoperative planning. Leveling biopsy with SILS offers an effective method for identifying the ganglionic zone in Hirschsprung disease. SIECo reduces diagnostic discrepancies and provides higher specificity for detecting ganglion cells compared to frozen sections before the pull-through procedure. SI-ECo leveling biopsy with immunohistochemistry offers a practical, accurate, and less invasive alternative for diagnosing and managing Hirschsprung disease. It reduces the risk of discrepancies observed with frozen sections, making it a viable option for facilities without access to frozen section technology. © 2025, Malaysian Medical Association. All rights reserved.