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Meta-Analysis
. 2015 Mar 24;5(3):e006063.
doi: 10.1136/bmjopen-2014-006063.

Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis

David Thomson  1 , Benjamin Allin  1 , Anna-May Long  1 , Tim Bradnock  2 , Gregor Walker  2 , Marian Knight  1
Affiliations
Meta-Analysis

Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis

David Thomson et al. BMJ Open. .

Abstract

Objective: To compare outcomes following totally transanal endorectal pull-through (TTERPT) versus pull-through with any form of laparoscopic assistance (LAPT) for infants with uncomplicated Hirschsprung's disease.

Design: Systematic review and meta-analysis.

Setting: Five hospitals with a paediatric surgical service.

Participants: 405 infants with uncomplicated Hirschsprung's disease.

Interventions: TTERPT versus LAPT.

Primary outcomes: mortality, postoperative enterocolitis, faecal incontinence, constipation, unplanned laparotomy or stoma formation, and injury to abdominal viscera.

Secondary outcomes: Haemorrhage requiring transfusion of blood products, abscess formation, intestinal obstruction, intestinal ischaemia, enteric fistula formation, urinary incontinence or retention, impotency and duration of procedure.

Results: Five eligible studies comprising 405 patients were identified from 2107 studies. All studies were retrospective case series, with variability in outcome assessment quality and length of follow-up. Operative duration was 50.29 min shorter with TTERPT (95% CI 39.83 to 60.74, p<0.00001). There were no significant differences identified between TTERPT and LAPT for incidence of postoperative enterocolitis (OR=0.78, 95% CI 0.44 to 1.38, p=0.39), faecal incontinence (OR=0.44, 95% CI 0.09 to 2.20, p=0.32) or constipation (OR=0.84, 95% CI 0.32 to 2.17, p=0.71).

Conclusions: This meta-analysis did not find any evidence to suggest a higher rate of enterocolitis, incontinence or constipation following TTERPT compared with LAPT. Further long-term comparative studies and multicentre data pooling are needed to determine whether a purely transanal approach offers any advantages over a laparoscopically assisted approach to rectosigmoid Hirschsprung's disease.

Trial registration number: PROSPERO registry- CRD42013005698.

Keywords: Hirschsprung disease; laparoscopy; meta-analysis; pull-through; transanal.

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Figures

Figure 1
Figure 1
PRISMA flow chart summarising study selection process.
Figure 2
Figure 2
Forest plot to show enterocolitis rates among infants undergoing totally transanal endorectal pull-through or laparoscopically assisted transanal pull-through.
Figure 3
Figure 3
Forest plot to show faecal incontinence among infants undergoing totally transanal endorectal pull-through or laparoscopically assisted transanal pull-through.
Figure 4
Figure 4
Forest plot to show constipation among infants undergoing totally transanal endorectal pull-through or laparoscopically assisted transanal pull-through.
See this image and copyright information in PMC

References

    1. Skaba R. Historic milestones of Hirschsprung's disease (commemorating the 90th anniversary of Professor Harald Hirschsprung's death). J Pediatr Surg 2007;42:249–51. 10.1016/j.jpedsurg.2006.09.024 - DOI - PubMed
    1. Swenson O, Bill AH Jr. Resection of rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing megacolon; an experimental study. Surgery 1948;24:212–20. - PubMed
    1. Duhamel B. A new operation for the treatment of Hirschsprung's disease. Arch Dis Child 1960;35:38–9. 10.1136/adc.35.179.38 - DOI - PMC - PubMed
    1. Soave F. Hirschsprung's disease: a new surgical technique. Arch Dis Child 1964;39:116–24. 10.1136/adc.39.204.116 - DOI - PMC - PubMed
    1. So HB, Schwartz DL, Becker JM et al. . Endorectal “pull-through” without preliminary colostomy in neonates with Hirschsprung's disease. J Pediatr Surg 1980;15:470–1. 10.1016/S0022-3468(80)80755-X - DOI - PubMed

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Supplementary concepts