Abstract
Objective
A meta-analysis was performed for a comparison of outcomes between open repair (OR) and thoracoscopic repair (TR) for esophageal atresia with tracheoesophageal fistula (EA with TEF).
Methods
Electronic databases, including PubMed, Cochrane Library, and Medline, were searched systematically for the literatures aimed mainly at comparing the therapeutic effects for EA with TEF administrated by OR and TR. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Meta-analysis was performed with Stata 12.0.
Results
Ten studies meeting the inclusion criteria were included, involving 447 subjects in total. It was observed that OR entailed a shorter operative time with significant statistical differences (SMD 0.604; 95% CI 0.344–0.864, P = 0). While TR was superior in two aspects: shorter length of hospital stay (SMD 0.584; 95% CI 0.214–0.953; P = 0.002) and shorter first oral feeding time (SMD 0.652; 95% CI 0.27–1.035; P = 0.001). However, meta-analyses of occurrence rate of leaks (OR, 1.747; 95% CI 0.817–3.737; P = 0.15), strictures (OR, 0.937; 95% CI 0.5–1.757; P = 0.839), pulmonary complications (OR, 1.08; 95% CI 0.21–5.44; P = 0.897), fundoplication rate of Gastroesophageal Reflux Disease (GERD) (OR, 1.642; 95% CI 0.855–3.153; P = 0.601), and blood loss (SMD 0.048; 95% CI −1.292 to 1.388; P = 0.944) showed no significant differences between OR and TR. Meta-analysis of ventilation time showed similar outcome between OR and TR (SMD 0.474; 95% CI 0.02–0.968; P = 0.06), but the result remained controversial due to estimated result changing after sensitivity analysis (SMD 0.61; 95% CI 0.16–1.07; P = 0).
Conclusions
Compared with OR, a longer operative time was associated within TR group, although the TR procedure could possibly reduce the length of hospital stay and first oral feeding time. Meanwhile, the occurrence rate for leaks, strictures, pulmonary complications, and the fundoplication rate of GERD, and blood loss were similar between the OR and TR groups. Estimated result of ventilation time between the two groups remained ambiguous.
Similar content being viewed by others
References
Rothenberg S (2014) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates: the current state of the art. Pediatr Surg Int 30(10):979–985
Alberti D, Boroni G, Corasaniti L et al (2011) Esophageal atresia: pre and post-operative management. J Matern Fetal Neonatal Med 24(Suppl 1):4–6
Rothenberg SS, Flake AW (2015) Experience with thoracoscopic repair of long gap esophageal atresia in neonates. J Laparoendosc Adv Surg Tech 25(11):932–935
Lobe TE, Stroedter L (1999) Thoracoscopic repair of esophageal atresia in an infant: a surgical first. J Laparoendosc Adv Surg Tech 3(3):141–148
Hu J, Wu Y, Wang J, Zhang C et al (2014) Thoracoscopic and laparoscopic plication of the hemidiaphragm is effective in the management of diaphragmatic eventration. Pediatr Surg Int 30(1):19–24
Rothenberg SS (2002) Thoracoscopic repair of tracheoesophageal fistula in newborns. J Pediatr Surg 37(6):869–872
Holcomb GW 3rd, Rothenberg SS, Bax KM et al (2005) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg 242(3):422–428
van der Zee DC, Bax KN (2007) Thoracoscopic treatment of esophageal atresia with distal fistula and of tracheomalacia. Semin Pediatr Surg 16(4):224–230
Huang J, Tao J, Chen K et al (2012) Thoracoscopic repair of oesophageal atresia: experience of 33 patients from two tertiary referral centres. J Pediatr Surg 47(12):2224–2227
Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716
Li S, Zeng XT, Ruan XL et al (2012) Simultaneous transurethral resection of bladder cancer and prostate may reduce recurrence rates: a systematic review and meta-analysis. Exp Ther Med 4(4):685–692
Higgins J, Green S (2014) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Naunyn Schmiedebergs Arch Pharmacol 5(2):S38
Guyatt GH, Oxman AD, Vist GE et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed) 336(7650):924–926
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13
Allal H, Perez-Bertolez S, Maillet O et al (2009) Comparative study of thoracoscopy versus thoracotomy in esophageal atresia. Cir Pediatr 22(4):177–180
Burford JM, Dassinger MS, Copeland DR et al (2011) Repair of esophageal atresia with tracheoesophageal fistula via thoracotomy: a contemporary series. Am J Surg 202(2):203–206
Kawahara H, Okuyama H, Mitani Y et al (2009) Influence of thoracoscopic esophageal atresia repair on esophageal motor function and gastroesophageal reflux. J Pediatr Surg 44(12):2282–2286
Koga H, Yamoto M, Okazaki T et al (2014) Factors affecting postoperative respiratory tract function in type-C esophageal atresia. Thoracoscopic versus open repair. Pediatr Surg Int 30(12):1273–1277
Lugo B, Malhotra A, Guner Y et al (2008) Thoracoscopic versus open repair of tracheoesophageal fistula and esophageal atresia. J Laparoendosc Adv Surg Tech 18(5):753–756
Ma L, Liu YZ, Ma YQ et al (2012) Comparison of neonatal tolerance to thoracoscopic and open repair of esophageal atresia with tracheoesophageal fistula. Chin Med J (Engl) 125(19):3492–3495
Matsunari Y, Kinouchi K, Ono R, Haruna J (2010) Comparison of thoracoscopic and open repair of esophageal atresia with tracheoesophageal fistula. Masui 59(10):1234–1240
Szavay PO, Zundel S, Blumenstock G et al (2011) Perioperative outcome of patients with esophageal atresia and tracheo-esophageal fistula undergoing open versus thoracoscopic surgery. J Laparoendosc Adv Surg Tech 21(5):439–443
Yamoto M, Urusihara N, Fukumoto K et al (2014) Thoracoscopic versus open repair of esophageal atresia with tracheoesophageal fistula at a single institution. Pediatr Surg Int 30(9):883–887
Bishay M, Giacomello L, Retrosi G et al (2013) Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg 258(6):895–900
Borruto FA, Impellizzeri P, Montalto AS et al (2012) Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula repair: review of the literature and meta-analysis. Eur J Pediatr Surg 22(6):415–419
Jaureguizar E, Vazquez J, Murcia J et al (1985) Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg 20(5):511–514
Rothenberg SS (2005) Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula. Semin Pediatr Surg 14(1):2–7
Yang YF, Dong R, Zheng C et al (2016) Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 95(30):e4428
Nakazato Y, Landing BH, Wells TR (1986) Abnormal Auerbach plexus in the esophagus and stomach of patients with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 21(10):831–837
Nguyen T, Zainabadi K, Bui T et al (2006) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: lessons learned. J Laparoendosc Adv Surg Tech 16(2):174–178
Al Tokhais T, Zamakhshary M, Aldekhayel S et al (2008) Thoracoscopic repair of tracheoesophageal fistulas: a case–control matched study. J Pediatr Surg 43(5):805–809
Woo S, Lau S, Yoo E et al (2015) Thoracoscopic versus open repair of tracheoesophageal fistulas and rates of vocal cord paresis. J Pediatr Surg 50(12):2016–2018
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors had no conflicts of interest to declare in relation to this article.
Rights and permissions
About this article
Cite this article
Wu, Y., Kuang, H., Lv, T. et al. Comparison of clinical outcomes between open and thoracoscopic repair for esophageal atresia with tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 33, 1147–1157 (2017). https://doi.org/10.1007/s00383-017-4153-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-017-4153-9