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 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<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.

研究目的：对比单纯经肛全直肠拖出术（totally transanal endorectal pull-through, TTERPT）与任何形式腹腔镜辅助拖出术（laparoscopic assistance, LAPT）治疗无并发症先天性巨结肠病（Hirschsprung's disease）患儿的术后结局。研究设计：系统评价与Meta分析。研究场景：5家设有儿科外科诊疗服务的医院。研究对象：405名无并发症先天性巨结肠病患儿。干预措施：TTERPT对比LAPT。主要与次要结局指标：主要结局包括死亡率、术后小肠结肠炎、大便失禁、便秘、非计划性开腹手术或造口形成，以及腹腔脏器损伤。次要结局包括需输注血液制品的出血、脓肿形成、肠梗阻、肠缺血、肠瘘形成、尿失禁或尿潴留、勃起功能障碍，以及手术时长。结果：从2107项研究中筛选出符合纳入标准的5项研究，共纳入405例患者。所有研究均为回顾性病例系列，结局评估质量与随访时长存在异质性。TTERPT组手术时长较LAPT组缩短50.29分钟（95%置信区间39.83~60.74，p<0.00001）。两组在术后小肠结肠炎发生率（比值比OR=0.78，95%CI 0.44~1.38，p=0.39）、大便失禁（OR=0.44，95%CI 0.09~2.20，p=0.32）或便秘（OR=0.84，95%CI 0.32~2.17，p=0.71）方面均无显著差异。结论：本Meta分析未发现证据表明TTERPT术后小肠结肠炎、失禁或便秘的发生率高于LAPT。仍需开展长期对比研究与多中心数据汇总，以明确纯经肛入路相较于腹腔镜辅助入路治疗直肠乙状结肠型先天性巨结肠病是否存在额外优势。