Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis.
BMJ Open
; 5(3): e006063, 2015 Mar 24.
Article
em En
| MEDLINE
| ID: mdl-25805527
ABSTRACT
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. PRIMARYOUTCOMES:
mortality, postoperative enterocolitis, faecal incontinence, constipation, unplanned laparotomy or stoma formation, and injury to abdominal viscera. SECONDARYOUTCOMES:
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 50.29â 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. TRIAL REGISTRATION NUMBER PROSPERO registry- CRD42013005698.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Canal Anal
/
Complicações Pós-Operatórias
/
Procedimentos Cirúrgicos do Sistema Digestório
/
Laparoscopia
/
Colo
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Doença de Hirschsprung
/
Megacolo
Tipo de estudo:
Systematic_reviews
Limite:
Humans
/
Infant
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article