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Laparoscopic versus open repair of recto-bladderneck and recto-prostatic anorectal malformations: a systematic review and meta-analysis

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Abstract

Objective

The laparoscopically-assisted anorectal pull-through (LAARP) for recto-bladderneck and recto-prostatic anorectal malformations (RB/RP-ARMs) is believed to improve patient outcomes. We performed a systematic review of the effect of LAARP on postoperative mucosal prolapse and defecation dysfunction.

Methods

A comprehensive search of MEDLINE, EMBASE, CENTRAL, and grey literature was performed (2000–2014). Full-text screening, data abstraction and quality appraisal were conducted in duplicate. Included studies reported a primary diagnosis of RB/RP-ARM and compared LAARP versus open repair (OPEN).

Results

From 3681 retrieved articles, 7 studies enrolling 187 patients were analyzed. One was a randomized control trial, 6 were retrospective observational studies, and all were single-centre. The majority were of poor-moderate quality (MINORS scores: mean 16.42 (SD 2.225) out of 24). Mucosal prolapse was not significantly different after LAARP versus OPEN (p = 0.18). Defecation outcomes were inconsistently reported but were no different between LAARP and OPEN for either children >3 years old (p = 0.84), or all ages combined (p = 0.11).

Conclusion

We found no significant difference in rates of mucosal prolapse or defecation scores for LAARP compared to OPEN for children with RB/RP-ARMs. However, studies are small and of poor-moderate quality and results are heterogeneous. Comprehensive, standardized, reliable reporting is necessary to guide practice and inform postoperative guidelines.

Level of evidence

1c.

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Acknowledgments

The authors would like to thank Neera Bhatnagar for her assistance with the search strategy, and Molly Barber for her assistance with editing the manuscript.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Pediatric General Surgery Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada

    Anna C. Shawyer

  2. Division of General Surgery, Western University, London, ON, Canada

    Michael H. Livingston

  3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Deborah J. Cook

  4. Division of Urology, McMaster University, Hamilton, ON, Canada

    Luis H. Braga

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  1. Anna C. Shawyer
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Correspondence to Anna C. Shawyer.

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Shawyer, A.C., Livingston, M.H., Cook, D.J. et al. Laparoscopic versus open repair of recto-bladderneck and recto-prostatic anorectal malformations: a systematic review and meta-analysis. Pediatr Surg Int 31, 17–30 (2015). https://doi.org/10.1007/s00383-014-3626-3

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