Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND: A thoracoscopic approach for repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) has become a standard procedure in many pediatric surgical centers. However, whether thoracotomy or thoracoscopy offer advantages in terms of surgical outcomes is not known. METHODS: To evaluate the efficacy and safety of thoracoscopic repair (TR) versus conventional open repair (COR) for EA with TEF. PubMed, Cochrane Library, and EMBASE were searched to identify relevant literature until 2016. Studies comparing surgical outcomes of patients undergoing TR versus COR for EA with TEF were reviewed. The quality of each included study was assessed using the Newcastle–Ottawa scale score. A fixed or random-effect model was applied depending on heterogeneity tests. RESULTS: Eight observational clinical studies involving 452 patients were included in this meta-analysis. The meta-analysis of 2 major postoperative complications (leaks and strictures) did not show significant differences between TR and COR. Overall estimates of the odds ratio (OR) of TR versus COR for leaks and strictures were: 1.57 (95% confidence interval [CI], 0.77–3.20; P = 0.22) and 0.90 (95% CI, 0.27–2.97; P = 0.86), respectively. However, meta-analysis of operation time (OR = 19.59, 95% CI = 0.77–38.40, P = 0.04), timing of extubation (OR = −2.50, 95% CI = −3.39 to −1.62, P < 0.001), time to 1st oral feeding (OR = −2.58, 95% CI = −3.79 to −1.36, P < 0.001), and duration of hospital stay (OR = −10.76, 95% CI = −16.39 to −5.12, P < 0.001) showed significant differences. No randomized controlled trial was included, and most studies had small sample sizes and were based on retrospective analysis. CONCLUSION: TR and COR show a similar complication rates of leaks and strictures for EA/TEF repair. Although associated with a longer operative time, TR has the advantages of an earlier time to extubation and 1st oral feeding, and shorter hospital stay.