A systematic review and meta-analysis of surgical techniques of long-gap esophageal atresia management

Abstract

Surgical management of patients with long-gap esophageal atresia (LGEA) is a complex task and various techniques have been proposed for the treatment of this population. According to the high rates of mortality and post-operative complications in this population, it is very important to choose the best method with the utmost care to minimize the consequences and to be sure of a result. Here, we conducted a systematic review and meta-analysis of the literature evaluating standard techniques for treating long-gap esophageal atresia to obtain a comprehensive picture of the outcomes and complications following each method. Materials and Method We comprehensively searched PubMed, Scopus, Web of Science, and Cochrane. Studies with eligible study designs, with study groups consisting of patients with LGEA, and evaluating outcomes of a particular surgical technique (including primary anastomosis (PA), esophageal lengthening (EL), and replacement), and published after 2005, were included. Two individuals independently screened each title, abstract, and full text. The quality of the papers was reviewed using appraisal instruments from the Joanna Briggs Institute (JBI). The meta-analysis process was performed using Review Manager and Comprehensive Meta-Analysis software. A random effect model was used for meta-analysis. Results: The search analyzed 54 studies, representing a total sample of 1103 patients. The meta-analysis revealed that open PA was significantly associated with post-operative anastomotic leakage, gastroesophageal reflux disease (GERD), stenosis/stricture, and other complications. EL was associated with leakage, GERD, stricture/stenosis, pneumonia, other complications, and the requirement for dilation, fundoplication, and re-operation. Gastric pull-up was associated with leakage, GERD, stricture/stenosis, pneumothorax, pneumonia, other complications, the requirement for dilation, fundoplication, and mortality. Jejunal interposition (JI) was associated with post-operative leakage, GERD, stricture/stenosis, pneumothorax, other complications, a requirement for dilation, re-operation, and mortality. Colonic interposition (CI) was associated with GERD, pneumothorax, pneumonia, other complications, and mortality.