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Meta-Analysis
. 2023 Jan 24;39(1):89.
doi: 10.1007/s00383-023-05378-1.

Transanal endorectal or transabdominal pull-through for Hirschsprung's disease; which is better? A systematic review and meta-analysis

Ulgen Celtik  1 , Idil Yavuz  2 , Orkan Ergün  3
Affiliations
Meta-Analysis

Transanal endorectal or transabdominal pull-through for Hirschsprung's disease; which is better? A systematic review and meta-analysis

Ulgen Celtik et al. Pediatr Surg Int. .

Abstract

Aim: Hesitations concerning the long-term results of transanal endorectal pull-through (TEPT) due to prolonged anal stretching and resultant stricture and continence problems has been started to be questioned. This meta-analysis intended to compare long-term results between TEPT and transabdominal (TAB) pull-through techniques in the surgical management of Hirschsprung's disease.

Methods: All publications between the years 1998-2021 in the PubMed, Medline, Google Scholar, Cochrane databases were reviewed. Retrospective and prospective comparative studies for TEPT, TAB as well as Laparoscopic-assisted TEPT (LTEPT) were included. Data included age at operation, postoperative constipation, enterocolitis, incontinence, stricture, and soiling rates.

Results: Eighteen publications met the inclusion criteria for TAB and TEPT, and six for TEPT and LTEPT. Patients who underwent TEPT had significantly younger operation age than patients with TAB (SMD - 1.02, 95%Cl - 1.85 to - 0.18, p: 0.0168). Postoperative constipation (OR 0.39, 95% Cl 0.25-0.61 p < 0.0001) and enterocolitis (OR 0.65, 95% Cl 0.46-0.90, p: 0.0108) rates were significantly lower in TEPT groups. Postoperative incontinence (OR 1.06, 95% Cl 0.56-2.01, p: 0.8468), stricture (OR 1.97, 95% Cl 0.81-4.80, p: 0.1352) and soiling rates were similar between the two groups. Furthermore, when TEPT and LTEPT results were compared, incidence of incontinence (OR 7.01, 95% Cl 0.75-65.33, p: 0.0871), constipation (OR 1.95, 95% Cl 0.70-5.37, p: 0.199), enterocolitis (OR 3.16, 95% Cl 0.34-29.55 p: 0.3137), stricture (OR 1.33, 95% Cl 0.29-6.15, p: 0.7188) and soiling (OR 1.57, 95% Cl 0.57-4.31, p: 0.3778) were similar for both techniques.

Discussion: TEPT is superior to TAB in terms of constipation and enterocolitis. Contrary to concerns, postoperative incontinence rates are not statistically different. However, further publications about long-term LTEPT results are necessary for more reliable conclusions.

Keywords: Endorectal pull-through; Enterocolitis; Hirschsprung’s disease; Incontinence; Laparoscopic-assisted pull-through.

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References

    1. Swenson O (2002) Hirschsprung’s disease: a review. Pediatrics 109:914–918. https://doi.org/10.1542/peds.109.5.914 - DOI - PubMed
    1. Duhamel B (1960) A new operation for the treatment of hirschsprung’s disease. Arch Dis Child 35:38–39. https://doi.org/10.1136/adc.35.179.38 - DOI - PubMed - PMC
    1. Soave F (1985) Endorectal pull-through: 20 years experience. Address of the guest speaker, APSA, 1984. J Pediatr Surg 20:568–579. https://doi.org/10.1016/S0022-3468(85)80003-8 - DOI - PubMed
    1. Boley SJ, Lafer DJ, Kleinhaus S, Cohn BD, Mestel ALKP (1968) Endorectal pull-through procedure for Hirschsprung’s disease with and without primary anastomosis. J Pediatr Surg 3:258–262 - DOI
    1. De La Torre-Mondragón L, Ortega-Salgado JA (1998) Transanal endorectal pull-through for Hirschsprung’s disease. J Pediatr Surg 33:1283–1286. https://doi.org/10.1016/S0022-3468(98)90169-5 - DOI - PubMed

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