Meta-analysis Of Transanal Endorectal Pull-through For Hirschsprung’s Disease Versus Transabdominal Operation

Aim: Transanal endorectal pull-through(TERPT)has become popular for 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 2017 were searched from Medline,Embase,Cochrane and Wanfang databases.Outcomes evaluated included operative time,hospital stay and incidence of postoperative incontinence/soiling,constipation and enterocolitis.Meta-analysis of the included studies was performed using Review Manger 5.3 software.Results: Of 11 studies,a total of 747 cases of Hirschsprung’s disease,of which 429 cases of TERPT surgery group,TAB surgery group of 318 cases.TERPT had shorter operative time(MD=-70.00 min,CI:-125.30~-14.70,P=0.01)and hospital stay(MD=-7.06 days,CI:-9.89~-4.23,P<0.00001).TERPT had less postoperative constipation(OR=0.51,CI : 0.27~0.97,P=0.04).There was no difference in incidence of postoperative incontinence/soiling and enterocolitis(P≥0.05).Conclusion: TERPT is safe and effective in children with Hirschsprung’s disease.It has the advantages of small trauma,short operation time 、quick recovery and less postoperative constipation.However,the incidence of postoperative incontinence/soiling and enterocolitis showed no significant difference.