One-stage versus two-stage surgery for the treatment of Hirschsprung’s disease: A Meta-analysis

doi:10.3877/cma.j.issn.1674-0793.2019.06.018

Abstract

Abstract:

Objective

To compare the postoperative complications and defecation function in patients with Hirschsprung’s disease (HD) treated with one-stage surgery (OS) and two-stage surgery (TS).

Methods

By searching Pubmed, Web of Science, CNKI, Wanfang databases, a comparative study of OS and TS surgical treatment of HD published before June 2018 was screened out. The relevant data in the included literature, publication bias and sensitivity were analyzed using STATA 14.0 software.

Results

Ten articles including 633 cases, nine English studies and one Chinese retrospective comparative study were retrieved. In terms of postoperative complications, there were no significant differences in the incidence of anastomotic stricture (OR=0.56, 95% CI: 0.29-1.09, P=0.087), anastomotic fistula (OR=1.01,95% CI: 0.16-6.51, P=0.995), intestinal obstruction (OR=0.88, 95% CI: 0.44-1.75, P=0.708), rectal prolapse (OR=1.29, 95% CI: 0.35-4.82, P=0.705), surgical site infection (OR=0.61, 95% CI: 0.31-1.20,P=0.152) and reoperation (OR=1.19, 95% CI: 0.66-2.16, P=0.563) between OS group and TS group. However, the incidence of postoperative hirschsprung-associated enterocolitis (HAEC) in the TS group was significantly lower than that of the OS group (OR=2.09, 95% CI: 1.34-3.25, P=0.001). In terms of defecation function, there were no significant differences in the rate of smooth defecation function (OR=1.08, 95% CI: 0.58-2.01, P=0.804), soiling (OR=0.60, 95% CI: 0.26-1.42, P=0.249) and fecal incontinence (OR=0.52, 95% CI: 0.17-1.55, P=0.237) between the two groups, but the incidence of constipation in the OS group was significantly lower than that of the TS group (OR=0.49, 95% CI: 0.30-0.81, P=0.006).

Conclusion

OS for HD can avoid the TS surgery associated complications, and compared with TS, the incidence of constipation is significantly lower, but the incidence of HAEC is significantly higher.

Key words: Hirschsprung disease, Colorectal surgery, Meta-analysis, One-stage surgery, Two-stage surgery

Chong Xie, Shuixue Li, Jun He, Yanfang Liu, Abudihebier Abula. One-stage versus two-stage surgery for the treatment of Hirschsprung’s disease: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(06): 496-504.

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Figures/Tables 15

References 31

[1]	Swenson O, Sherman JO, Fisher JH, et al. The treatment and postoperative complications of congenital megacolon: A 25 year followup[J]. Ann Surg, 1975, 182(3): 266-273.
[2]	So HB, Schwartz DL, Becker JM, et al. Endorectal "pull-through" without preliminary colostomy in neonates with Hirschsprung’s disease[J]. J Pediatr Surg, 1980, 15(4): 470-471.
[3]	Bradnock TJ, Walker GM. Evolution in the management of Hirschsprung’s disease in the UK and Ireland: A national survey of practice revisited[J]. Ann R Coll Surg Engl, 2011, 93(1): 34-38.
[4]	Bufo AJ, Chen MK, Shah R, et al. Analysis of the costs of surgery for Hirschsprung’s disease: one-stage laparoscopic pull-through versus two-stage Duhamel procedure[J]. Clin Pediatr (Phila), 1999, 38(10): 593-596
[5]	Kumar R, Mackay A, Borzi P. Laparoscopic Swenson procedure--an optimal approach for both primary and secondary pull-through for Hirschsprung’s disease[J]. J Pediatr Surg, 2003, 38(10): 1440-1443.
[6]	Ademuyiwa AO, Bode CO, Idiodi-Thomas HO, et al. Early outcome of open primary pull through versus staged pull through in Hirschsprung’s disease: A single centre experience from Nigeria[J].Nig Qt J Hosp Med, 2012, 22(3): 164-167.
[7]	Cheung ST, Tam YH, Chong HM. An 18-year experience in total colonic aganglionosis: from staged operations to primary laparoscopic endorectal pull-through[J]. J Pediatr Surg, 2009, 44(12): 2352-2354.
[8]	Hackam DJ, Superina RA, Pearl RH. Single-stage repair of Hirschsprung’s disease: A comparison of 109 patients over 5 years[J]. J Pediatr Surg, 1997, 32(7): 1028-1031; discussion 1031-1032.
[9]	Ramesh JC, Ramanujam TM, Yik YI, et al. Management of Hirschsprung’s disease with reference to one-stage pull-through without colostomy[J]. J Pediatr Surg, 1999, 34(11): 1691-1694.
[10]	Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung’s disease: practice trends and outcomes in infants[J]. J Pediatr Surg, 2014, 49(11): 1619-1625.
[11]	Shinall MC Jr, Koehler E, Shyr Y, et al. Comparing cost and complications of primary and staged surgical repair of neonatally diagnosed Hirschsprung’s disease[J]. J Pediatr Surg, 2008, 43(12): 2220-2225.
[12]	Aslanabadi S, Ghalehgolab-Behbahan A, Zarrintan S, et al. Transanal one-stage endorectal pull-through for Hirschsprung’s disease: A comparison with the staged procedures[J]. Pediatr Surg Int, 2008, 24(8): 925-929.
[13]	Langer JC, Fitzgerald PG, Winthrop AL, et al. One-stage versus two-stage Soave pull-through for Hirschsprung’s disease in the first year of life[J]. J Pediatr Surg, 1996, 31(1): 33-36.
[14]	Skarsgard ED, Superina RA, Shandling B, et al. Initial experience with one-stage endorectal pull-through procedures for Hirschsprung’s disease[J]. Pediatr Surg Int, 1996, 11(7): 480-482.
[15]	Pierro A, Fasoli L, Kiely EM, et al. Staged pull-through for rectosigmoid Hirschsprung’s disease is not safer than primary pull-through[J]. J Pediatr Surg, 1997, 32(3): 505-509.
[16]	Santos MC, Giacomantonio JM, Lau HY. Primary Swenson pull-through compared with multiple-stage pull-through in the neonate[J]. J Pediatr Surg, 1999, 34(7): 1079-1081.
[17]	van der Zee DC, Bax KN. One-stage Duhamel-Martin procedure for Hirschsprung’s disease: A 5-year follow-up study[J]. J Pediatr Surg, 2000, 35(10): 1434-1436.
[18]	Teitelbaum DH, Cilley RE, Sherman NJ, et al. A decade of experience with the primary pull-through for hirschsprung disease in the newborn period: A multicenter analysis of outcomes[J]. Ann Surg, 2000, 232(3): 372-380.
[19]	Liu CS, Chin TW, Wei CF. Neonatal Duhamel’s pull-through for Hirschsprung’s disease[J]. Zhonghua Yi Xue Za Zhi (Taipei), 2002, 65(8): 398-402.
[20]	Auwera AV, Mekahli D, Janssens V, et al. Primary laparoscopic-assisted pull-through compared with open three-stage procedure for Hirschsprung’s disease[J]. J Pediatr Gastr Nutr, 2005, 40(10): 667.
[21]	Chiengkriwate P, Patrapinyokul S, Sangkhathat S, et al. Primary pull-through with modified Duhamel technique: 1 institution’s experience[J]. J Pediatr Surg, 2007, 42(6): 1075-1080.
[22]	郑百俊, 王怀杰, 高亚, 等. 腹腔镜辅助根治长段型巨结肠远期疗效观察[J]. 中华小儿外科杂志, 2015, 36(11): 824-828.
[23]	Singh SJ, Croaker GD, Manglick P, et al. Hirschsprung’s disease: the Australian Paediatric Surveillance Unit’s experience[J]. Pediatr Surg Int, 2003, 19(4): 247-250.
[24]	Suita S, Taguchi T, Ieiri S, et al. Hirschsprung’s disease in Japan: analysis of 3 852 patients based on a nationwide survey in 30 years[J]. J Pediatr Surg, 2005, 40(1): 197-201; discussion 201-202.
[25]	Haricharan RN, Seo JM, Kelly DR, et al. Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not[J]. J Pediatr Surg, 2008, 43(6): 1115-1123.
[26]	Stockmann PT, Philippart AI. The Duhamel procedure for Hirschsprung’s disease[J]. Semin Pediatr Surg, 1998, 7(2): 89-95.
[27]	Zimmer J, Tomuschat C, Puri P. Long-term results of transanal pull-through for Hirschsprung’s disease: A Meta-analysis[J]. Pediatr Surg Int, 2016, 32(8): 743-749.
[28]	Elhalaby EA, Coran AG, Blane CE, et al. Enterocolitis associated with Hirschsprung’s disease: A clinical-radiological characterization based on 168 patients[J]. J Pediatr Surg, 1995, 30(1): 76-83.
[29]	Pastor AC, Osman F, Teitelbaum DH, et al. Development of a standardized definition for Hirschsprung’s-associated enterocolitis: A Delphi analysis[J]. J Pediatr Surg, 2009, 44(1): 251-256.
[30]	Jamieson DH, Dundas SE, Belushi SA, et al. Does the transition zone reliably delineate aganglionic bowel in Hirschsprung’s disease?[J]. Pediatr Radiol, 2004, 34(10): 811-815.
[31]	Somme S, Langer JC. Primary versus staged pull-through for the treatment of Hirschsprung disease[J]. Semin Pediatr Surg, 2004, 13(4): 249-255.

第一作者发表年	国家/地区	病例数（例）		男女比例		根治手术平均年龄		移行段位置（例）		并发畸形（例）		随访时间		手术方式
第一作者发表年	国家/地区	一期	二期	一期	二期	一期	二期	一期	二期	一期	二期	一期	二期	一期	二期
Langer 1996^[13]	加拿大	13	23	10:3	17:6	无	无	RS:10;DC:1;TVC:2	RS:17;DC:6	7	10	平均14个月	平均19个月	So
Skarsgard 1996^[14]	加拿大	7	20	7:0	14:6	2个月	21个月	RS:7	RS:20	0	0	无		So
Pierro 1997^[15]	英国	28	59	无	无	NA	NA	RS:28	RS:59	5	6	无		Du:25 Sw:3	Du:47 Sw:8 So:4
Santos 1999^[16]	加拿大	18	47	无	无	5 d	268 d	RS:14;DC:2;AC:2	RS:37;DC:8;AC:2	3	11	3~33个月	1~10个月	Sw:18	Sw:41 So:4 Du:2
Van der Zee 2000^[17]	荷兰	29	27	无	无	无	无	RS:29	RS:27	0	0	5~7年	8~14年	Du
Teitelbaum 2000^[18]	美国	78	103	57:21	69:34	18 d	19.6个月	RS:58;DC:7;AC:3;TC:8	RS:76 DC:6;TVC:10;TC:8	28	32	无		So
Liu 2002^[19]	中国台湾	23	27	17:6	20:7	无	无	RS:17;LSA:6	RS:19;LSA:5;TC:3	无	无	2~20年		Du
Auwera 2005^[20]	比利时	8	8	7:1	无	4 d	11个月	RS:8	RS:8	无	无	3个月至3年		Sw
Chiengkriwate 2007^[21]	泰国	30	20	27:3	13:7	72 d	144 d	RS:28;DC:1;TVC:1	RS:13;DC:6;TVC:1	无	无	12个月	16个月	Du
郑百俊2015^[22]	中国	26	39	19:7	29:10	7个月	8个月	LSA:26	LSA:39	3	3	5年以上		So

第一作者发表年	国家/地区	病例数（例）		男女比例		根治手术平均年龄		移行段位置（例）		并发畸形（例）		随访时间		手术方式
第一作者发表年	国家/地区	一期	二期	一期	二期	一期	二期	一期	二期	一期	二期	一期	二期	一期	二期
Langer 1996^[13]	加拿大	13	23	10:3	17:6	无	无	RS:10;DC:1;TVC:2	RS:17;DC:6	7	10	平均14个月	平均19个月	So
Skarsgard 1996^[14]	加拿大	7	20	7:0	14:6	2个月	21个月	RS:7	RS:20	0	0	无		So
Pierro 1997^[15]	英国	28	59	无	无	NA	NA	RS:28	RS:59	5	6	无		Du:25 Sw:3	Du:47 Sw:8 So:4
Santos 1999^[16]	加拿大	18	47	无	无	5 d	268 d	RS:14;DC:2;AC:2	RS:37;DC:8;AC:2	3	11	3~33个月	1~10个月	Sw:18	Sw:41 So:4 Du:2
Van der Zee 2000^[17]	荷兰	29	27	无	无	无	无	RS:29	RS:27	0	0	5~7年	8~14年	Du
Teitelbaum 2000^[18]	美国	78	103	57:21	69:34	18 d	19.6个月	RS:58;DC:7;AC:3;TC:8	RS:76 DC:6;TVC:10;TC:8	28	32	无		So
Liu 2002^[19]	中国台湾	23	27	17:6	20:7	无	无	RS:17;LSA:6	RS:19;LSA:5;TC:3	无	无	2~20年		Du
Auwera 2005^[20]	比利时	8	8	7:1	无	4 d	11个月	RS:8	RS:8	无	无	3个月至3年		Sw
Chiengkriwate 2007^[21]	泰国	30	20	27:3	13:7	72 d	144 d	RS:28;DC:1;TVC:1	RS:13;DC:6;TVC:1	无	无	12个月	16个月	Du
郑百俊2015^[22]	中国	26	39	19:7	29:10	7个月	8个月	LSA:26	LSA:39	3	3	5年以上		So

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