title: Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis.
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.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Five hospitals with a paediatric surgical service.
  
  
  METHODS
  405 infants with uncomplicated Hirschsprung's disease.
  
  
  METHODS
  TTERPT versus LAPT.
  
  
  METHODS
  
  
  
  METHODS
  mortality, postoperative enterocolitis, faecal incontinence, constipation, unplanned laparotomy or stoma formation, and injury to abdominal viscera.
  
  
  RESULTS
  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 50.29 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.
  
  
  BACKGROUND
  PROSPERO registry- CRD42013005698.
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors: David
authors: D
authors: Thomson
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors: Benjamin
authors: B
authors: Allin
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors: Anna-May
authors: AM
authors: Long
authors: Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, UK.
authors: Tim
authors: T
authors: Bradnock
authors: Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, UK.
authors: Gregor
authors: G
authors: Walker
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors: Marian
authors: M
authors: Knight
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D003106:Colon / Q000473:pathology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008531:Megacolon / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications
keywords: Hirschsprung disease; laparoscopy; meta-analysis; pull-through; transanal