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Thoracoscopy vs. thoracotomy for the repair of esophageal atresia and tracheoesophageal fistula: a systematic review and meta-analysis

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Abstract

Esophageal atresia (EA) and tracheoesophageal fistula (TEF) require emergency surgery in the neonatal period to prevent aspiration and respiratory compromise. Surgery was once exclusively performed via thoracotomy; however, there has been a push to correct this anomaly thoracoscopically. In this study, we compare intra- and post-operative outcomes of both techniques. A systematic review and meta-analyses was performed. A search strategy was developed in consultation with a librarian which was executed in CENTRAL, MEDLINE, and EMBASE from inception until January 2017. Two independent researchers screened eligible articles at title and abstract level. Full texts of potentially relevant articles were then screened again. Relevant data were extracted and analyzed. 48 articles were included. A meta-analysis found no statistically significant difference between thoracoscopy and thoracotomy in our primary outcome of total complication rate (OR 0.98, [0.29, 3.24], p = 0.97). Likewise, there were no statistically significant differences in anastomotic leak rates (OR 1.55, [0.72, 3.34], p = 0.26), formation of esophageal strictures following anastomoses that required one or more dilations (OR 1.92, [0.93, 3.98], p = 0.08), need for fundoplication following EA repair (OR 1.22, [0.39, 3.75], p = 0.73)—with the exception of operative time (MD 30.68, [4.35, 57.01], p = 0.02). Considering results from thoracoscopy alone, overall mortality in patients was low at 3.2% and in most cases was due to an associated anomaly rather than EA repair. Repair of EA/TEF is safe, with no statistically significant differences in morbidity when compared with an open approach.

Level of evidence 3a systematic review of case–control studies.

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Abbreviations

EA:

Esophageal atresia

TEF:

Tracheoesophageal fistula

MA:

Meta-analyses

RCTs:

Randomized controlled trials

MD:

Mean differences

OR:

Odds ratios

CI:

Confidence intervals

SRs:

Systematic reviews

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  1. Department of Pediatric Surgery, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Colin Way, Carolyn Wayne, Viviane Grandpierre, Brittany J. Harrison, Nicole Travis & Ahmed Nasr

  2. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Colin Way & Brittany J. Harrison

  3. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Ahmed Nasr

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  1. Colin Way
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Way, C., Wayne, C., Grandpierre, V. et al. Thoracoscopy vs. thoracotomy for the repair of esophageal atresia and tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 35, 1167–1184 (2019). https://doi.org/10.1007/s00383-019-04527-9

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