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Published on: April 26, 2019
Systematic review and meta-analysis of enterocolitis after one-stage transanal pull-through procedure for
1National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin-12, Ireland.
Insights
The transanal one-stage pull-through procedure (TERPT) for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Hirschsprung's disease (HD) is a congenital condition requiring surgical intervention.
- The transanal one-stage pull-through procedure (TERPT) is increasingly favored over open and laparoscopic methods for HD.
- Enterocolitis associated with Hirschsprung's disease (HAEC) is a significant postoperative complication.
Purpose of the Study:
- To evaluate the postoperative incidence of HAEC following the TERPT procedure.
- To assess the safety and efficacy of TERPT in managing Hirschsprung's disease.
Main Methods:
- A meta-analysis of published TERPT cases between 1998 and 2009.
- Inclusion of 27 articles reporting on 899 patients who underwent TERPT.
- Detailed recording of intraoperative factors and postoperative complications, focusing on HAEC incidence.
Main Results:
- Postoperative HAEC occurred in 10.2% of patients (92/899).
- Recurrent HAEC episodes were reported in 2% of patients.
- Conservative treatment was successful in 81.5% of HAEC cases; 18.5% required surgery.
Conclusions:
- TERPT is a safe and minimally invasive surgical option for Hirschsprung's disease.
- The incidence of postoperative HAEC following TERPT is relatively low.
- Most HAEC cases can be managed conservatively.
Purpose:
The transanal one-stage pull-through procedure (TERPT) has gained worldwide popularity over open and laparoscopic-assisted one-stage techniques in children with Hirschsprung's disease (HD). It offers the advantages of avoiding laparotomy, laparoscopy, scars, abdominal contamination, and adhesions. However, enterocolitis associated with Hirschsprung's disease (HAEC) still remains to be a potentially life-threatening complication after pull-through operation. The reported incidence of HAEC ranges from 4.6 to 54%. This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure.
Methods:
A meta-analysis of cases of TERPT reported between 1998 and 2009 was performed. Detailed information was recorded regarding intraoperative details and postoperative complications with particular emphasis on incidence of HAEC. Diagnosis of HAEC in a HD patient was based on the clinical presentation of diarrhoea, abdominal distension, and fever.
Results:
Of the 54 published articles worldwide, 27 articles, including 899 patients were identified as reporting entirely TERPT procedure. Postoperative HAEC occurred in 92 patients (10.2%). Recurrent episodes of HAEC were reported in 18 patients (2%). Conservative treatment of HAEC was successful in 75 patients (81.5%), whereas in 17 patients (18.5%) surgical treatment was needed.
Conclusions:
This systematic review reveals that TERPT is a safe and less-invasive procedure with a low incidence of postoperative HAEC.
