Morphological and Proteomic Characterisation of the Myenteric Plexus in Hirschsprung Disease Transition Zones in Nigerian Children: Implications for Surgical Resection Margins

Hirschsprung disease results from failure of neural crest cell migration during gastrointestinal development, producing an aganglionic colonic segment that causes functional intestinal obstruction in neonates. Surgical treatment requires resection of the aganglionic bowel to a proximal ganglionic margin, but the histological and molecular anatomy of the transition zone between ganglionic and aganglionic bowel remains incompletely characterised. Misidentification of the transition zone contributes to postoperative obstructive symptoms after pull-through surgery. This study aims to perform morphological and proteomic characterisation of the myenteric plexus across ganglionic, transition zone, and aganglionic colonic segments in Nigerian children with Hirschsprung disease undergoing definitive pull-through surgery at the University of Benin Teaching Hospital, Joyland Children's Hospital Enugu, and Lagos Island General Hospital. Immunohistochemistry for S100, calretinin, and neurofilament will delineate ganglion cell characteristics and neural hypertrophy patterns. Confocal microscopy with three-dimensional reconstruction will map the structural architecture of myenteric plexus networks across zones. Laser capture microdissection followed by liquid chromatography-mass spectrometry will generate proteome profiles of each colonic segment. Integration of morphological and proteomic data will define molecular biomarkers of the transition zone boundary, supporting the development of intraoperative diagnostic algorithms to improve resection margin accuracy in Nigerian paediatric surgical centres.

Keywords: Hirschsprung disease, myenteric plexus, transition zone, proteomics, paediatric surgery