Department of General Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Pediatric Surgery, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2024 Jul 1;27(7):392-399. doi: 10.34172/aim.28183.
The timing of trans-anal endorectal pull-through (TAEPT) for Hirschsprung's disease (HD) is controversial. Early endorectal pull-through avoids the occurrence of preoperative enterocolitis. However, delayed pull-through (≥31 days) enables postnatal maturation of the anal canal and sphincter complex. The aim of this study was to identify the best age to perform trans-anal pull-through according to the literature.
This is a comprehensive systematic review. All articles published from 2010 to 2022 were searched in the Web of Science, Ovid Medline, PubMed, CINAHIL, and Embase databases, using the keywords HD, delayed or early treatment, trans-anal pull-through surgery, age, sex or gender, complications and outcomes. Articles that met the inclusion criteria with good to fair quality according to the Newcastle-Ottawa quality assessment and low bias score in the Cochran collaboration tool were reviewed.
Sixteen studies were eligible to be reviewed. The overall results of this study showed that due to more common short-term complications at neonatal period and lower contrast enema diagnostic accuracy in determining the transition zone, it seems to be reasonable decision to postpone surgery until the child is several months old. There was also no difference in terms of complications and outcomes of trans-anal pull-through surgery between females and males.
It is not recommended to delay surgery too much for ages over 1 year. Ages between 3 and 12 months can be a good time for interventional treatment for HD.
先天性巨结肠症（HD）经肛门内拖出术（TAEPT）的时机存在争议。早期经肛门内拖出术可避免术前发生结肠炎。然而，延迟拖出术（≥31 天）可使肛门和括约肌复合体在出生后成熟。本研究旨在根据文献确定经肛门拖出术的最佳年龄。
这是一项全面的系统评价。在 Web of Science、Ovid Medline、PubMed、CINAHIL 和 Embase 数据库中使用 HD、延迟或早期治疗、经肛门拖出术、年龄、性别或性别、并发症和结果等关键词，搜索 2010 年至 2022 年发表的所有文章。根据纽卡斯尔-渥太华质量评估标准和 Cochrane 协作工具中的低偏倚评分，对符合纳入标准且质量良好至中等的文章进行了回顾。
有 16 项研究符合纳入标准。本研究的总体结果表明，由于新生儿期更常见的短期并发症和确定过渡区的对比灌肠诊断准确性较低，因此将手术推迟到几个月大似乎是合理的决定。女性和男性经肛门拖出术的并发症和结果也没有差异。
不建议将手术延迟超过 1 年以上。3 至 12 个月之间的年龄可以是 HD 介入治疗的好时机。
