Meta-analysis Of Laparoscopic-assisted Operations Versus Pena Operation For Middle And High Anorectal Malformations

Objective: To evaluate the efficacy of laparoscopic-assisted anoplasty and posterior sagittal anoplasty in the treatment of high and middle anorectal malformations,and to compare the advantages and disadvantages of the two surgical procedures,so as to provide a reference for clinical treatment of congenital anorectal malformations.Methods:The literatures of laparoscopic-assisted anal angioplasty and posterior sagittal anusoplasty were published from January 2000 to January 2010 in PubMed,EBSCO,Wanfang database and Chinese Journal Net.The operative time,postoperative hospital stay,the incidence of complications,the results of rectal anal canal(anal anal resting pressure and anal canal pressure),postoperative bowel function(kelly score).Meta-analysis of the included studies was performed using Review Manger 5.3 software.Results:Nine articles included in this study,a total of 325 cases of high and middle anorectal malformation cases,of which 167 cases of LAARP surgery group,PSARP surgery group of 158 cases.Meta-analysis showed that the operation time was shorter in laparoscopic surgery group(WMD =-25.74,CI:-45.24 ~-6.24,P = 0.01).There was significant difference in postoperative hospital stay(WMD =-3.16,CI:-3.81 ~-2.50,P <0.00001).The length of hospitalization was shorter in laparoscopic group.The difference of postoperative complication rate,rectal anal canal pressure assessment and postoperative bowel function showed no statistically significant(P≥0.05).Conclusion: Laparoscopic-assisted anoplasty is safe and effective in children with middle and high anorectal malformation.It has the advantages of small trauma,short operation time and quick recovery.At the same time,the incidence of postoperative complications and postoperative bowel function showed no significant difference compared with posterior sagittal anoplasty.