Journal article
Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis.
- Abstract:
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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.
Primary and secondary outcome measures
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 followup. 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 795.1KB, Terms of use)
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- Publisher copy:
- 10.1136/bmjopen-2014-006063
Authors
- Funding agency for:
- Knight, M
- Grant:
- Professorship
- Publisher:
- BMJ Publishing Group
- Journal:
- BMJ Open More from this journal
- Volume:
- 5
- Issue:
- 3
- Pages:
- e006063
- Publication date:
- 2015-03-01
- Acceptance date:
- 2014-11-12
- DOI:
- EISSN:
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2044-6055
- ISSN:
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2044-6055
- Language:
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English
- Keywords:
- Pubs id:
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pubs:517054
- UUID:
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uuid:096f7ae8-9801-4726-a06c-36382f3073c3
- Local pid:
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pubs:517054
- Source identifiers:
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517054
- Deposit date:
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2016-04-07
- ARK identifier:
Terms of use
- Copyright holder:
- Knight et al
- Copyright date:
- 2015
- Notes:
- This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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