title: Laparoscopic Duhamel Procedure for Hirschsprung's Disease: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Since its introduction in 1956, the Duhamel procedure has been and remains one of the most widely performed for Hirschsprung's disease (HD). The most significant modification to this procedure has been the incorporation of laparoscopy, while the original principles of the method have been retained. This study compared long-term outcomes for open Duhamel (OD) and laparoscopic Duhamel (LD) procedures for HD, to identify any added advantage of the laparoscopic technique.
  
  
  METHODS
  We undertook a systematic review of all studies published over a period of 20 years (1994-2014) that assessed functional outcomes for OD and/or LD procedures. Odds ratios were calculated for dichotomous variables, and mean difference values were calculated for continuous variables.
  
  
  RESULTS
  From 11 articles 456 patients were included (253 OD, 203 LD), with no significant difference in age at surgery and length of follow-up (P > .05). The open group had a significantly greater incidence of soiling/incontinence (11% versus 4%; P = .02) and further surgery (25% versus 14%; P = .005), longer hospital stay (9.79 versus 7.3 days; P < .00001), and time to oral feed (4.05 versus 3.27 days; P < .00001). Operative time was significantly longer in the laparoscopic group (3.83 versus 4.09 hours; P = .004). There was no significant difference in incidence of enterocolitis (15% versus 10%; P = .14) and constipation (23% versus 30%; P = .12).
  
  
  CONCLUSIONS
  Our meta-analysis convincingly demonstrates the superiority of LD over OD pull-through for HD. Prospective, randomized control trials are required to overcome limitations in the current literature.
authors: Department of Paediatric Surgery, Birmingham Children's Hospital , Birmingham, United Kingdom .
authors: Daniel W
authors: DW
authors: Scholfield
authors: Department of Paediatric Surgery, Birmingham Children's Hospital , Birmingham, United Kingdom .
authors: Ashok Daya
authors: AD
authors: Ram
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome