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

Abstract

ObjectiveTo 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.DesignSystematic review and meta-analysis.SettingFive hospitals with a paediatric surgical service.Participants405 infants with uncomplicated Hirschsprung's disease.InterventionsTTERPT versus LAPT.Primary and secondary outcome measuresPrimary outcomes: mortality, postoperative enterocolitis, faecal incontinence, constipation, unplanned laparotomy or stoma formation, and injury to abdominal viscera.Secondary outcomesHaemorrhage requiring transfusion of blood products, abscess formation, intestinal obstruction, intestinal ischaemia, enteric fistula formation, urinary incontinence or retention, impotency and duration of procedure.ResultsFive 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).ConclusionsThis 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 numberPROSPERO registry- CRD42013005698.

Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease

“…1 The surgical treatment involves removal of the aganglionic segment and anastomosis of the innervated proximal bowel to the anus. 2 Bowel dysfunction, particularly varying degrees of fecal incontinence, are observed after all operative techniques for HD, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] although direct comparison of outcomes between series is challenging due to substantial variations in the methods used for the assessment of bowel function, length of follow-up, and inclusion criteria. During the past decades, 1-stage transanal endorectal pull-through (TEPT) has become one of the most commonly performed operations for HD.…”

“…3,4,23 The procedure can be performed totally transanally or in combination with transabdominal colonic mobilization using laparotomy or laparoscopy. [3][4][5][6][7][8][9][23][24][25] However, it has been suggested that bowel mobilization and dissection through the anus has the potential to interfere with anal sphincter integrity and rectal sensation, 3,6,8 but controlled studies of the long-term outcomes after TEPT are lacking. It has also been established that significant impairment of fecal control negatively impacts on quality of life (QoL) and social problems, [26][27][28] and validated assessment of the long-term QoL among HD patients after TEPT is timely.…”

Beginning experience with the transanal endorectal pull-through operation for the surgical treatment of Hirschsprung’s Disease

“…'nın (9) laparoskopik yaklaşımının ardından 1998'de bildirilen TERPT yöntemiyle farklı bir noktaya taşınmıştır (1,12,13) . Hh tanısının lavman opak, anal manometri, yatakta yüzeyel emme biyopsisi ile konabilmesine karşın (14,15) , klasikleşmiş yöntem hala tam kat rektal biyopsi alınmasıdır.…”

“…Perineal dermatit, anastomoz darlığı, enterokolit, dışkı kaçırma ve kabızlık gibi çeşitli komplikasyonlardan TERPT'ye özgü olan yalnız dermatit olup bunun da tedavisi, bazen biraz zahmetli olmakla birlikte, sorun kalmayacak şekilde yapılabilmektedir (3,11,12,14,16,21,22,(26)(27)(28)(29) .…”

Developments in pediatric colorectal pathologies

“…Transanal endorektal pull-pull through operasyonuna göre ameliyat süresi daha uzun olarak meta-analizlerde tanımlanmıştır (5) . Açık cerrahiye göre ise kan kaybı, hastanede kalış süresi, bağırsak hareketliliğinde ve komplikasyon sayısında anlamlı düşüklük mevcuttur (6) .…”