title: Transanal endorectal pull-through versus transabdominal approach for Hirschsprung's disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Transanal endorectal pull-through (TERPT) has become popular for single-stage treatment of Hirschsprung's disease. The benefits of TERPT over the conventional transabdominal approach (TAB) are still unclear. We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB.
  
  
  METHODS
  Original articles published from 1998 to 2012 were searched from Medline, Embase, and Cochrane databases. Randomized controlled trials (RCT) and observational clinical studies (OCS) comparing TERPT and TAB were included. Outcomes evaluated included operative time, hospital stay and incidence of postoperative incontinence/soiling, constipation and enterocolitis. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables.
  
  
  RESULTS
  Of 93 studies, 1 RCT and 11 OCS were included, comprising 444 cases of TERPT and 348 cases of TAB (215 Soave, 94 Duhamel, 24 Swenson, 15 Rehbein procedures). TERPT had shorter operative time (MD=-57.85 min; 95% confidence interval [CI], -83.11 to -32.60; P<0.00001) and hospital stay (MD=-7.06 days; 95% CI, -10.95 to -3.16; P=0.0004). TERPT had less postoperative incontinence/soiling (OR=0.58; 95% CI 0.37-0.90; P=0.01) and constipation (OR=0.49; 95% CI 0.30-0.81; P=0.005). There was no difference in incidence of postoperative enterocolitis.
  
  
  CONCLUSIONS
  TERPT is superior to TAB in operative time, hospital stay, postoperative incontinence and constipation. However, more randomized controlled trials are necessary to verify the benefit of TERPT for Hirschsprung's disease.
authors.affiliation: Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore 229899, Singapore.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.forename: Shireen A
authors.initials: SA
authors.lastname: Nah
authors.forename: Narasimhan Kannan
authors.initials: NK
authors.lastname: Laksmi
authors.forename: Caroline C P
authors.initials: CC
authors.lastname: Ong
authors.forename: Joyce H Y
authors.initials: JH
authors.lastname: Chua
authors.forename: Anette
authors.initials: A
authors.lastname: Jacobsen
authors.forename: Yee
authors.initials: Y
authors.lastname: Low
mesh_terms: D000005:Abdomen; D001003:Anal Canal; D002648:Child; D013505:Digestive System Surgical Procedures / Q000379:methods; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D012007:Rectum