Hirschsprung ' s disease . Suction biopsy in

In the management of chronic constipation Hirschsprung's disease may be diagnosed on the basis of radiological investigation, anorectal manometry, and rectal biopsy. Though x ray films and manometric studies may be highly suggestive, the definitive diagnosis requires rectal biopsy.' 2 The classical method of rectal biopsy involves taking a full thickness of rectal mucosa and underlying muscle, requiring general anaesthesia and suturing of the biopsy wound. The possible complications necessitate inpatient management, and its morbidity precludes its use as a screening procedure. The introduction of suction rectal biopsy of mucosa and submucosa represents a considerable advance.3 4 Biopsy requires neither general anaesthesia nor suturing, may be carried out even on outpatients, is suitable for all ages, and rarely leads to complications. Several teams have reported false negative results when compared with full thickness biopsy.5 We investigated over 2000 children with chronic constipation and suspected Hirschsprung's disease and performed suction biopsies on 400 of them. To assess the validity of the suction results we are reviewing all the cases (72) in which full thickness biopsies were also carried out, either at a formal resection or at upper partial sphincterotomy.