| Background and Objective:At present,domestic and foreign have studied the advantages and disadvantages of laparoscopic-assisted transanal endorectal pull-through and totally transanal endorectal pull-through in the treatment of Hirschsprung's disease,but there are many arguments about them,and it is still unclear which operative method is better for the treatment of Hirschsprung's disease.The purpose of this study was to compare outcomes following totally transanal endorectal pull-through(TTERPT)versus pull-through with any form of laparoscopic assistance(LAPT)for infants with Hirschsprung's disease.Design:Systematic review and meta-analysisMethod:Retrieved the articles from 1998 to 2019,which published in the Pubmed,Embase,Cochrane library,Chinese National Knowledge Infrastructure(CNKI),VIP,Wanfang database about compare laparoscopic-assisted transanal endorectal pull-through versus totally transanal endorectal pull-through for infants with Hirschsprung's disease.Carried out statistical analysis on operation time,postoperative length of stay,amount of blood loss,dissection times and postoperative enterocolitis,constipation,fecal incontinence/soil,torsion of colon,adhesion intestinal obstruction,perianal dermatitis.Meta-analysis of the included studies was performed using the Review Manager v.5.3 software.Results:A total of 14 articles involved 1115 children with Hirschsprung's disease were included in the study,532cases underwent laparoscopic-assisted transanal endorectal pull-through operation and 583 cases underwent totally transanal endorectal pull-through operation.Meta-analysis results showed that there was a statistical difference between two operative methods,the operative time of totally transanal endorectal pull-through surgery group was shorter(MD=28.33min,95%CI 14.12?42.54,P<0.0001);there was a statistically difference in postoperative length of stay,and the postoperative length of stay was shorter with laparoscopic-assisted transanal endorectal pull-through(MD=-2.28days,95%CI-3.67?-0.89,P=0.001);laparoscopic-assisted transanal endorectal pull-through surgery group had less blood loss and the difference was statistically significant(MD=-7.80ml,95%CI-10.51?-5.08,P<0.00001);The difference in dissection times was statistically significant(MD=-32.23min,95%CI-39.92?-24.53,P<0.00001),laparoscopically assisted transanal pull-through surgery group has a shorter dissection times.In postoperative complications:there was a statistically significant difference in the incidence of colon twist between the two groups(OR=0.21,95%CI 0.05?0.88,P=0.03),laparoscopically assisted transanal pull-through with less incidence of colon twist.There was no statistically significant difference in the incidence of postoperative enterocolitis,fecal incontinence/soil,adhesive intestinal obstruction,constipation and perianal dermatitis(P values?0.05).Conclusion:The treatment of congenital megacolon through totally transanal pull-through has the advantages of short operation time,laparoscopically assisted transanal pull-through group had short postoperative hospital stay,less blood loss,short dissection times and low incidence of colonic volvulus.There was no significant differences in the incidence of postoperative enterocolitis,constipation,fecal incontinence/soil,adhesive intestinal obstruction,and perianal dermatitis between the two surgical procedures. |
PDF Full Text Request