Data from: Laparoscopic assistance for primary transanal pull-through in Hirschsprung’s disease: a systematic review and meta-analysis.

Objective: To compare outcomes following totally transanal 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: Totally transanal pull-through (TTERPT) versus pull-through with any form of laparoscopic assistance (LAPT) Primary and secondary outcome measures: Primary outcomes: mortality, post-operative 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 2,107 studies. All studies were retrospective case series, with variability in outcome assessment quality and length of follow-up. Operative duration was 50.29 minutes shorter with TTERPT (95% CI 39.83-60.74,p<0.00001). There were no significant differences identified between TTERPT and LAPT for incidence of post-operative enterocolitis (OR 0.78, 95% CI 0.44-1.38, p=0.39), faecal incontinence (OR 0.44, 95% CI 0.09-2.20, 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 to LAPT. Further long-term comparative studies and multi-centre data-pooling are needed to determine whether a purely transanal approach offers any advantages over a laparoscopically-assisted approach to rectosigmoid Hirschsprung’s disease.