LAPAROSCOPIC-ASSISTED ANO-RECTAL PULL-THROUGH vs. POSTERIOR SAGITTAL ANO-RECTOPLASTY: A SYSTEMATIC REVIEW OF COMPARATIVE STUDIES

PURPOSE: Laparoscopic-assisted anorectal pull-through (LAARP) is becoming an increasingly common procedure to correct high and intermediate anorectal malformations (ARMs), but the level of evidence supporting this approach is unclear. Our aim is to review systematically the literature comparing LAARP to posterior sagittal ano-rectoplasty (PSARP) with regard to indications, complications, functional outcomes, and quality of reporting. METHOD: A systematic search of the MEDLINE and PUBMED (June 2000 to April 2014) was conducted. The search terms used were “laparoscopic,” “pull-through,” “anorectal malformation” and “imperforate anus. A careful review of references of all included articles was conducted to ensure capture of all eligible articles. Only comparative studies published in full in English were included. RESULTS: Thirteen studies were included in the final analysis. One study was randomized, 2 were prospective in nature, and 10 compared retrospectively outcomes of PSARP and LAARP. The studies included 409 patients (219 LAARP, 190 PSARP; 335 males, 74 females) treated for high/intermediate ARMs. Reported outcomes included intraoperative parameters (operative time, bleeding, surgical stress, all favouring LAARP) and post-operative complications. Morpho-functional outcomes (manometry: 6 studies; contrast enema: 2 studies; magnetic resonance: 2 studies; endoanal ultrasound, 1 studies) and methods to evaluate clinical outcomes (Kelly score 4 studies; Krickenbech scoring system 4 studies, others scoring systems 3 studies) varied widely between reports, precluding a meta-analysis. CONCLUSION: The number of good quality studies dealing with LAARP is still low. There is a need for both a standardization of outcomes measures and improvement in the quality of reporting LAARP results. This will ultimately allow for evidence based surgical decision making