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

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 paediat...

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Bibliographic Details
Published in:	BMJ open 2015-03, Vol.5 (3), p.e006063-e006063
Main Authors:	Thomson, David, Allin, Benjamin, Long, Anna-May, Bradnock, Tim, Walker, Gregor, Knight, Marian
Format:	Article
Language:	eng
Subjects:	Abdomen Anal Canal - surgery Biopsy Colon - pathology Constipation Digestive System Surgical Procedures - adverse effects Digestive System Surgical Procedures - methods Dissection Hirschsprung Disease - complications Hirschsprung Disease - surgery Humans Infant Laparoscopy Laparoscopy - adverse effects Laparoscopy - methods Libraries Megacolon - complications Megacolon - surgery Mortality Ostomy Postoperative Complications Studies Surgery Systematic review
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Summary:	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 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 follow-up. Operative duration was 50.29 min shorter with TTERPT (95% CI 39.83 to 60.74, p
ISSN:	2044-6055 2044-6055