Laparoscopic-assisted anorectal pull-through for anorectal malformations: a systematic review and the need for standardization of outcome reporting.
BACKGROUND
Laparoscopic-assisted anorectal pull-through (LAARP) is becoming an increasingly common procedure to correct high and intermediate anorectal malformations (ARMs). The aim of this review was to evaluate worldwide experiences with LAARP with regard to indications, outcomes, and quality of reporting.


METHODS
A systematic review was conducted. The search was limited to studies reported in English and performed in humans. In addition to Medline and PubMed, a manual search of the Journal of Pediatric Surgery, Pediatric Surgery International, Surgical Endoscopy, and the Journal of Laparoendoscopic & Advanced Surgical Techniques published between June 2000 and April 2008 was conducted.


RESULTS
Seventeen studies were included in the final analysis. Of the included studies, none were randomized, 2 were prospective in nature, and 4 compared outcomes of posterior sagittal anorectoplasty and LAARP. The studies included 124 patients (96 males, 28 females) with 80% reported as having high/intermediate malformations. All studies reported short-term outcomes. Reported outcomes included continence, rectal prolapse, the position of the rectum (7 studies using Kelly score), manometry (1 study), contrast enema (1 study), postanal endosonography (3 studies), and postoperative magnetic resonance imaging (3 studies). Outcomes varied widely between reports precluding a meta-analysis.


CONCLUSIONS
The number of studies dealing with LAARP is low. There is a need for both a standardization and improvement in the quality of reporting in LAARP research. This will ultimately allow for evidence-based surgical decision making.
Al-Hozaim
Omar
O
Division of Pediatric Surgery, King Saud bin Abdulaziz University for Health Sciences University, Riyadh 1446, Saudi Arabia.
Al-Maary
Jamila
J
AlQahtani
Aayed
A
Zamakhshary
Mohammed
M
D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D001006:Anus, Imperforate / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000601:surgery*; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D012107:Research Design; D016896:Treatment Outcome