Single-incision laparoscopic endorectal pull-through for Hirschsprung disease: a prospective institutional study and systematic review with meta-analysis.

BACKGROUND

Single-incision laparoscopic endorectal pull-through (SILEP) has emerged as an alternative to conventional laparoscopic surgery for Hirschsprung disease (HSCR), offering improved cosmetic outcomes with comparable efficacy. However, its adoption remains limited, and evidence supporting its long-term safety and functional outcomes is sparse. This study presents our institutional experience with SILEP, alongside a systematic review and meta-analysis evaluating perioperative outcomes, postoperative complications, bowel function, and cosmesis.

PATIENTS AND

METHODS

A prospective study was conducted at our institution involving 93 pediatric patients diagnosed with HSCR, who underwent SILEP between 2020 and 2021. Demographic data, perioperative details, and postoperative outcomes, including bowel function score (Rintala) and cosmetic results (Manchester Scar Scale), were prospectively collected and analyzed. Additionally, a systematic review and meta-analysis were performed following PRISMA guidelines, pooling data from nine studies comprising 420 patients.

RESULTS

The mean operative time was 70.0 ± 30.3 min, significantly shorter than the pooled estimate from the meta-analysis (166.44 min; 95% CI 137.74-195.14, p < 0.001). No intraoperative complications or conversions were recorded. The mean hospital stay was 5.23 ± 2.69 days, consistent with prior reports. Enterocolitis occurred in 16.1% of cases, comparable to the pooled estimate (12%; 95% CI 7-21%). Among patients aged ≥ 4 years (n = 64), 84% achieved good to excellent bowel function scores. The mean Manchester Scar Score was 5.73 ± 1.38.

CONCLUSION

SILEP is a safe, effective, and cosmetically superior approach for HSCR, with favorable perioperative outcomes and functional results. Our findings, supported by meta-analysis data, reinforce the feasibility of SILEP as a viable alternative for HSCR management.