Abstract
Aim There is still no consensus about the optimal surgical approach for esophageal replacement
in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures.
The aim of this article was to perform a meta-analysis comparing the most widely used
techniques for esophageal replacement in children: jejunal interposition (JI), colon
interposition (CI), and gastric pull-up (GPU).
Methods Review of the English-language literature published in the past 5 years about esophageal
replacement in children was done. The focus was on postoperative survival rate, morbidity
(gastrointestinal complications such as anastomotic stenosis/leakage and respiratory
complications such as pneumothorax, pneumonia, and atelectasis), and long-term follow-up
when available. Among long-term gastrointestinal outcomes were dysphagia, reflux,
and dumping; among long-term respiratory outcomes were recurrent pneumonia and recurrent
aspiration leading to chronic lung disease. Data were computed by Comprehensive Meta-Analysis
software (Version 2.2.064).
Main Results A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective)
including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI,
99 (21%) GPU, and 27 (6%) JI. Among these 15 studies, 9 provided data about long-term
follow-up.
Conclusion Proper prospective comparative studies are lacking. GPU and CI appear comparable
regarding postoperative mortality, anastomotic complications, and graft loss. On the
long-term, GPU seems to be associated with a higher respiratory morbidity but fewer
gastrointestinal complications than CI. Based on this article only two series provide
data about JI, and they show highly divergent results. JI appears to be a valid replacement
technique when performed by experienced centers; however larger numbers are needed
to assess the outcomes of this procedure.
Keywords
long-gap esophageal atresia - esophageal replacement - meta-analysis
