Transanal endorectal or transabdominal pull-through for Hirschsprung's disease; which is better? A systematic review and meta-analysis.
Pediatr Surg Int
; 39(1): 89, 2023 Jan 24.
Article
em En
| MEDLINE
| ID: mdl-36692536
ABSTRACT
AIM:
Hesitations concerning the long-term results of transanal endorectal pull-through (TEPT) due to prolonged anal stretching and resultant stricture and continence problems has been started to be questioned. This meta-analysis intended to compare long-term results between TEPT and transabdominal (TAB) pull-through techniques in the surgical management of Hirschsprung's disease.METHODS:
All publications between the years 1998-2021 in the PubMed, Medline, Google Scholar, Cochrane databases were reviewed. Retrospective and prospective comparative studies for TEPT, TAB as well as Laparoscopic-assisted TEPT (LTEPT) were included. Data included age at operation, postoperative constipation, enterocolitis, incontinence, stricture, and soiling rates.RESULTS:
Eighteen publications met the inclusion criteria for TAB and TEPT, and six for TEPT and LTEPT. Patients who underwent TEPT had significantly younger operation age than patients with TAB (SMD - 1.02, 95%Cl - 1.85 to - 0.18, p 0.0168). Postoperative constipation (OR 0.39, 95% Cl 0.25-0.61 p < 0.0001) and enterocolitis (OR 0.65, 95% Cl 0.46-0.90, p 0.0108) rates were significantly lower in TEPT groups. Postoperative incontinence (OR 1.06, 95% Cl 0.56-2.01, p 0.8468), stricture (OR 1.97, 95% Cl 0.81-4.80, p 0.1352) and soiling rates were similar between the two groups. Furthermore, when TEPT and LTEPT results were compared, incidence of incontinence (OR 7.01, 95% Cl 0.75-65.33, p 0.0871), constipation (OR 1.95, 95% Cl 0.70-5.37, p 0.199), enterocolitis (OR 3.16, 95% Cl 0.34-29.55 p 0.3137), stricture (OR 1.33, 95% Cl 0.29-6.15, p 0.7188) and soiling (OR 1.57, 95% Cl 0.57-4.31, p 0.3778) were similar for both techniques.DISCUSSION:
TEPT is superior to TAB in terms of constipation and enterocolitis. Contrary to concerns, postoperative incontinence rates are not statistically different. However, further publications about long-term LTEPT results are necessary for more reliable conclusions.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Procedimentos Cirúrgicos do Sistema Digestório
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Enterocolite
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Doença de Hirschsprung
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Humans
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Infant
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article