Surgical outcomes of laparoscopic-assisted pull-through operations for Hirschsprung disease: a systematic review and meta-analysis

Hirschsprung disease (HD) is a congenital intestinal neuropathy characterised by distal colonic aganglionosis. While laparoscopic-assisted pull-through (LAPT) has gained widespread adoption, existing evidence is limited by study heterogeneity, retrospective designs, and non-standardised outcome definitions. This study aimed to systematically evaluate the safety profile, complications, and functional outcomes following LAPT for HD. We searched PubMed, Scopus, Cochrane Library, and Web of Science through May 2025, adhering to PRISMA 2020 standards. We included studies that enrolled ≥ 10 patients undergoing LAPT and had ≥ 6-month follow-up. Pooled proportions were calculated via Freeman–Tukey double-arcsine transformation with DerSimonian–Laird random-effects models. Study quality was appraised using a modified NIH tool. Thirty-three studies (2,415 patients) met the inclusion criteria. The pooled conversion rate was 1% (95% CI: 0–2%), the mean operative time was 150 min (95% CI: 135–166), and the intraoperative complication rate was 5% (95% CI: 2–9%). Anastomotic leak occurred in 2% (95% CI: 1–3%; I² = 0%). HAEC developed early in 9% (95% CI: 6–13%; I² = 83.5%) and late in 11% (95% CI: 8–15%; I² = 66.4%). Faecal incontinence occurred in 9% (95% CI: 5–16%) and constipation in 8% (95% CI: 5–11%). The reoperation rate was 4% (95% CI: 2–7%), and the mortality rate was 1% (95% CI: 1–2%; I² = 0%). Technique-specific subgroup analyses showed no significant differences for most outcomes. LAPT for HD demonstrates excellent perioperative safety with low mortality and conversion rates. However, persistent HAEC and functional complications remain concerning. Pooled estimates for outcomes with high heterogeneity (I² > 75%) should be interpreted as descriptive summaries. Standardised outcome definitions, validated functional assessment tools, and high-quality comparative trials are needed to optimise technique selection.