Laparoscopic assistance for primary transanal pull-through in XXXX : a systematic review and meta-analysis.

@entity1 @entity322 @entity548 @entity1963 @entity3511 @entity292 @entity733 @entity86 @entity1321 @entity1964 @entity1142
OBJECTIVE: To compare outcomes following totally transanal endorectal pull-through (TTERPT) versus pull-through with any form of laparoscopic assistance (LAPT) for @entity1 with uncomplicated @entity1963 . DESIGN: Systematic review and meta-analysis. SETTING: Five hospitals with a paediatric surgical service. @entity1 : 405 @entity1 with uncomplicated @entity1963 . INTERVENTIONS: TTERPT versus LAPT. PRIMARY AND SECONDARY OUTCOME MEASURES:                 <AbstractText Label="PRIMARY OUTCOMES" NlmCategory="METHODS">mortality, @entity86 , @entity322 , @entity1142 , unplanned laparotomy or stoma formation, and @entity3511 . SECONDARY OUTCOMES: @entity548 requiring transfusion of blood products, @entity733 formation, @entity1321 , intestinal ischaemia, enteric @entity292 formation, @entity322 or retention, impotency and duration of procedure. RESULTS: Five eligible studies comprising 405 @entity1 were identified from 2107 studies. All studies were retrospective case series, with variability in outcome assessment quality and length of follow-up. Operative duration was 50.29   min shorter with TTERPT (95% CI 39.83 to 60.74, p<0.00001). There were no significant differences identified between TTERPT and LAPT for incidence of @entity86 (OR=0.78, 95% CI 0.44 to 1.38, p=0.39), @entity322 (OR=0.44, 95% CI 0.09 to 2.20, p=0.32) or @entity1142 (OR=0.84, 95% CI 0.32 to 2.17, p=0.71). CONCLUSIONS: This meta-analysis did not find any evidence to suggest a higher rate of @entity1964 , @entity322 or @entity1142 following TTERPT compared with LAPT. Further long-term comparative studies and multicentre data pooling are needed to determine whether a purely transanal approach offers any advantages over a laparoscopically assisted approach to rectosigmoid @entity1963 . TRIAL REGISTRATION NUMBER: PROSPERO registry- CRD42013005698.
