Review ArticleTransanal endorectal pull-through versus transabdominal approach for Hirschsprung's disease: A systematic review and meta-analysis
Section snippets
Literature search and data extraction
We searched all publications from August 1998 to March 2012 in the MEDLINE, EMBASE and Cochrane library databases and the Cochrane Controlled Trials Register using different combinations of the following terms: “Hirschsprung's disease,” “transanal,” “perineal approach,” “transabdominal” and “pull-through.” The reference lists of the full articles were also manually searched to identify additional eligible studies. After identifying relevant titles and abstracts, the studies were assessed for
Results
Of 93 studies reporting the outcome of the transanal approach in treating Hirschsprung's disease, 18 studies that compared outcome after TERPT with those after TAB were eligible for inclusion in our analysis. Two studies used a different methodology for assessment of postoperative results from other studies and were excluded [26], [27]. Four studies contained data that overlapped with later studies from the same centers [13], [25], [28], [29], leaving 1 RCT and 11 OCS for meta-analysis [10],
Discussion
Our meta-analysis suggests that the TERPT is superior to the conventional TAB pull-through for Hirschsprung's disease. To our knowledge, this study is the first systematic review and meta-analysis comparing TERPT to TAB pull-through for Hirschsprung's disease.
TERPT is a minimally invasive procedure, with the advantages of better cosmesis, less postoperative pain and avoidance of abdominal contamination [8]. Many studies have also suggested that TERPT reduces operative time and hospital stay
Limitations
Our results appear to favor TERPT for most postoperative outcomes. However, this result must be interpreted cautiously due to the limitations of this study. The lack of randomized trials is a key problem. Only one RCT was available and this RCT compared TERPT with the multi-stage Swenson procedure that has fallen out of favor in recent years. Most of the included studies were small retrospective studies which are prone to selection bias and may result in uneven distribution of confounding
Acknowledgments
The authors would like to thank Mr. Fahad Javaid Siddiqui, Assistant Professor of Epidemiology, Singapore Clinical Research Institute, for his invaluable help with statistical analysis.
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These authors contributed equally to this work.