title: Laparoscopic versus open repair of recto-bladderneck and recto-prostatic anorectal malformations: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The laparoscopically-assisted anorectal pull-through (LAARP) for recto-bladderneck and recto-prostatic anorectal malformations (RB/RP-ARMs) is believed to improve patient outcomes. We performed a systematic review of the effect of LAARP on postoperative mucosal prolapse and defecation dysfunction.
  
  
  METHODS
  A comprehensive search of MEDLINE, EMBASE, CENTRAL, and grey literature was performed (2000-2014). Full-text screening, data abstraction and quality appraisal were conducted in duplicate. Included studies reported a primary diagnosis of RB/RP-ARM and compared LAARP versus open repair (OPEN).
  
  
  RESULTS
  From 3681 retrieved articles, 7 studies enrolling 187 patients were analyzed. One was a randomized control trial, 6 were retrospective observational studies, and all were single-centre. The majority were of poor-moderate quality (MINORS scores: mean 16.42 (SD 2.225) out of 24). Mucosal prolapse was not significantly different after LAARP versus OPEN (p = 0.18). Defecation outcomes were inconsistently reported but were no different between LAARP and OPEN for either children >3 years old (p = 0.84), or all ages combined (p = 0.11).
  
  
  CONCLUSIONS
  We found no significant difference in rates of mucosal prolapse or defecation scores for LAARP compared to OPEN for children with RB/RP-ARMs. However, studies are small and of poor-moderate quality and results are heterogeneous. Comprehensive, standardized, reliable reporting is necessary to guide practice and inform postoperative guidelines.
  
  
  METHODS
  1c.
authors.affiliation: Department of Pediatric Surgery, Pediatric General Surgery Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada, annashawyer@gmail.com.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Shawyer
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Luis H
authors.initials: LH
authors.lastname: Braga
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011469:Prostatic Diseases / Q000601:surgery*; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000601:surgery*