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Pediatric Surgery International

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01-12-2023 | Constipation | Review Article

Transanal endorectal or transabdominal pull-through for Hirschsprung’s disease; which is better? A systematic review and meta-analysis

Authors: Ulgen Celtik, Idil Yavuz, Orkan Ergün

Published in: Pediatric Surgery International | Issue 1/2023

Abstract

Aim

Hesitations concerning the long-term results of transanal endorectal pull-through (TEPT) due to prolonged anal stretching and resultant stricture and continence problems has been started to be questioned. This meta-analysis intended to compare long-term results between TEPT and transabdominal (TAB) pull-through techniques in the surgical management of Hirschsprung’s disease.

Methods

All publications between the years 1998–2021 in the PubMed, Medline, Google Scholar, Cochrane databases were reviewed. Retrospective and prospective comparative studies for TEPT, TAB as well as Laparoscopic-assisted TEPT (LTEPT) were included. Data included age at operation, postoperative constipation, enterocolitis, incontinence, stricture, and soiling rates.

Results

Eighteen publications met the inclusion criteria for TAB and TEPT, and six for TEPT and LTEPT. Patients who underwent TEPT had significantly younger operation age than patients with TAB (SMD − 1.02, 95%Cl − 1.85 to − 0.18, p: 0.0168). Postoperative constipation (OR 0.39, 95% Cl 0.25–0.61 p < 0.0001) and enterocolitis (OR 0.65, 95% Cl 0.46–0.90, p: 0.0108) rates were significantly lower in TEPT groups. Postoperative incontinence (OR 1.06, 95% Cl 0.56–2.01, p: 0.8468), stricture (OR 1.97, 95% Cl 0.81–4.80, p: 0.1352) and soiling rates were similar between the two groups. Furthermore, when TEPT and LTEPT results were compared, incidence of incontinence (OR 7.01, 95% Cl 0.75–65.33, p: 0.0871), constipation (OR 1.95, 95% Cl 0.70–5.37, p: 0.199), enterocolitis (OR 3.16, 95% Cl 0.34–29.55 p: 0.3137), stricture (OR 1.33, 95% Cl 0.29–6.15, p: 0.7188) and soiling (OR 1.57, 95% Cl 0.57–4.31, p: 0.3778) were similar for both techniques.

Discussion

TEPT is superior to TAB in terms of constipation and enterocolitis. Contrary to concerns, postoperative incontinence rates are not statistically different. However, further publications about long-term LTEPT results are necessary for more reliable conclusions.

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Title: Transanal endorectal or transabdominal pull-through for Hirschsprung’s disease; which is better? A systematic review and meta-analysis
Authors: Ulgen Celtik
Idil Yavuz
Orkan Ergün
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Constipation
Constipation
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05378-1

At a glance: The STEP trials

Springer Medicine

Transanal endorectal or transabdominal pull-through for Hirschsprung’s disease; which is better? A systematic review and meta-analysis

Abstract

Aim

Methods

Results

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Aim

Methods

Results

Discussion

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