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

Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease

“…1 The surgical treatment involves removal of the aganglionic segment and anastomosis of the innervated proximal bowel to the anus. 2 Bowel dysfunction, particularly varying degrees of fecal incontinence, are observed after all operative techniques for HD, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] although direct comparison of outcomes between series is challenging due to substantial variations in the methods used for the assessment of bowel function, length of follow-up, and inclusion criteria. During the past decades, 1-stage transanal endorectal pull-through (TEPT) has become one of the most commonly performed operations for HD.…”

“…3,4,23 The procedure can be performed totally transanally or in combination with transabdominal colonic mobilization using laparotomy or laparoscopy. [3][4][5][6][7][8][9][23][24][25] However, it has been suggested that bowel mobilization and dissection through the anus has the potential to interfere with anal sphincter integrity and rectal sensation, 3,6,8 but controlled studies of the long-term outcomes after TEPT are lacking. It has also been established that significant impairment of fecal control negatively impacts on quality of life (QoL) and social problems, [26][27][28] and validated assessment of the long-term QoL among HD patients after TEPT is timely.…”

Advances in minimally invasive neonatal colorectal surgery

“…Reported operative time for the open approach ranges from 91.3-297 min, laparoscopic approach from 150-257 min, and trans-anal approach from 43.5-258 min. Meta-analyses directly comparing these techniques demonstrated a shorter operating time in laparoscopic procedures and trans-anal procedures[51,52]. Reported length of stay for open procedures range from 6.9 to 18.7 d, laparoscopic-assisted procedures from 3.6 to 10.4 d and trans-anal endorectal procedures from 2.6 to 9.8 d. Two studies comparing laparoscopic vs open procedures showed a significantly shorter average length of stay with laparoscopic procedures; 4 d following the laparoscopic endorectal pull-through, 7 d with the laparoscopic Duhamel pull-through and 10 d after an open Duhamel pull-through[46,53].…”

“…Reported length of stay for open procedures range from 6.9 to 18.7 d, laparoscopic-assisted procedures from 3.6 to 10.4 d and trans-anal endorectal procedures from 2.6 to 9.8 d. Two studies comparing laparoscopic vs open procedures showed a significantly shorter average length of stay with laparoscopic procedures; 4 d following the laparoscopic endorectal pull-through, 7 d with the laparoscopic Duhamel pull-through and 10 d after an open Duhamel pull-through[46,53]. When compared to the transabdominal approach, both the laparoscopic-assisted pull-through and the trans-anal endorectal pull-through have been shown to have a shorter length of stay[51,52]. …”

Neonatal surgery: Towards evidence-based practice and management

“…A typical example is retrospective institutional studies comparing different surgical methods to treat Hirschsprung's disease. 2 Retrospective cohort studies have usually used historical controls, i.e., patients operated during a certain time period with a certain technique are compared with another cohort that has previously undergone a different operation. Studies using concurrent controls are much more uncommon in neonatal surgical literature.…”