Abstract
Introduction The thoracoscopic approach to esophageal atresia (EA) with tracheoesophageal fistula
(TOF) represents a challenging procedure whose real benefits remains unclear. Our
purpose is to identify, through a meta-analysis, clinical evidence of the reliability
of the thoracoscopic repair (TR) for EA/TOF compared with the open repair.
Materials and Methods Defined PubMed search, with analysis of intraoperative and postoperative complications
after open or thoracoscopic primary anastomosis for EA/TOF.
Results Five articles met the criteria of meta-analysis, being comparative studies between
TR and conventional open repair (COR), although they were retrospective. One article
was excluded because it was available only in Japanese. We observed a slight prevalence,
statistically insignificant, of the intraoperative and postoperative complication
rate for TR: odds ratio (OR) 1.29. Excluding the conversion rate, the meta-analysis
between the complication rate for TR and COR did not show a significant difference
(OR 0.64). Anastomosis's leaks and strictures considered together did not show a significant
difference between the two techniques, p = not significant and OR of 0.56. Similar results were observed analyzing the single
outcome of leaks and strictures; the meta-analysis did not show any significant differences
with an OR, respectively, of 1.05 and 0.43.
Conclusions The effectiveness of the endoscopic technique for EA/TOF repair is indicated with
outcomes not different from open surgery. A randomized controlled trial is needed
in this field to indicate which procedure is superior, open or TR.
Keywords
esophageal atresia - tracheoesophageal fistula - thoracoscopy - meta-analysis
