Portal de Periódicos da CAPES

Transanal endorectal pull-through versus transabdominal approach for Hirschsprung's disease: A systematic review and meta-analysis

2013; Elsevier BV; Volume: 48; Issue: 3 Linguagem: Inglês

10.1016/j.jpedsurg.2012.12.036

1531-5037

Yong Chen, Shireen Anne Nah, Narasimhan Kannan Laksmi, Caroline Ong, Joyce Horng Yiing Chua, Anette Jacobsen, Yee Low,

Diverticular Disease and Complications

Aim 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. Conclusion 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.