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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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 REVIEW ARTICLE
Year : 2023  |  Volume : 28  |  Issue : 5  |  Page : 357-368

Can neonatal pull-through replace staged pull-through for the management of anorectal malformation? A systematic review and meta-analysis


1 Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
2 Department of Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Vivek Manchanda
Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi - 110 031
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_28_23

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Anorectal malformations (ARMs) are managed classically in three stages – colostomy at birth, anorectal pull-through after 2–3 months, and stoma closure. Single-stage pull-through has been contemplated in neonatal age aimed to reduce the number of procedures, better long-term continence, the better psycho-social status of the child, and reduced cost of treatment, especially in resource-strained countries. We conducted a systematic review comparing neonatal single-stage pull-through with stage pull-through and did a meta-analysis for the outcome and complications. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PubMed and Scopus databases were searched and RevMan 5.4.1 was used for the meta-analysis. Fourteen comparative studies including one randomized controlled trial were included in the systematic review for meta-analysis. The meta-analysis included 1845 patients including 866 neonates undergoing single-stage pull-through. There was no statistically significant difference for the occurrence of surgical site infection (odds ratio [OR] 0.82, 95% confidence interval [CI]: 0.24–2.83), urinary tract injury (OR 1.82, 95% CI: 0.85–3.89), rectal prolapse (OR 0.98, 95% CI: 0.21–5.04), anal stenosis/stricture, voluntary bowel movements (OR 0.97, 95% CI: 0.25–3.73), constipation (OR 1.01, 95% CI: 0.61–1.67), soiling (OR 0.89, 95% CI: 0.52–1.51), mortality (OR 1.19, 95% CI: 0.04–39.74), or other complications. However, continence was seen to be better among patients undergoing neonatal pull-through (OR 1.63, 95% CI: 1.12–2.38). Thus, we can recommend single-stage pull-through for managing patients with ARMs in the neonatal age.






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