SYSTEMATIC BIBLIOGRAPHICAL REVIEW AND META-ANALYSIS OF THORACOSCOPIC VS. OPEN-SURGICAL TREATMENT OF ESOPHAGEAL ATRESIA

Abstract

Thoracoscopic reconstruction of esophageal atresia (EA) has become a standard procedure in many surgical centers Worldwide. The existing bibliographical reviews and meta-analyses have failed to demonstrate any significant difference in the immediate outcome of mini-aggressive treatment of EA. Authors had performed this truly systematic review and meta-analysis searching for the new evidence and confirmation of success of thoracoscopy in the treatment of EA. Materials and methods used: the systematic bibliographical review was prepared in accordance with the PRISMA 2020 statement guidelines. Thus, the scientific publications starting 1990 were searched in three major databases as follows: MEDLINE, PubMed and eLIBRARY.RU. Results: the included studies were published between 2008 and 2022 representing a total of 1958 cases that included 1369 (69.92%) open-surgery interventions and 589 (30.08%) thoracoscopic ones. Authors have found no significant difference between thoracoscopy and thoracotomy excluding an increased risk for esophageal anastomotic leak in the open-surgery treatment group (OR, 0.68; 95% CI, 0.46; 0.99; p = 0.04). A meta-analysis demonstrated that the thoracoscopy group had shorter time spent on lung ventilation (MD, -1.83; 95% CI, -3.02; -0.63; p = 0.003), shorter period to start oral feeding (MD, -1.34; 95% CI, -2.13; -0.56; p = 0.0008) and shorter hospital stay (MD, -4.26; 95% CI, -7.03; -1.49; p = 0.003). The data on the long-term outcomes of both thoracoscopic and open-surgery interventions were reported in a limited - insufficient number of observed cases and had demonstrated that gastroesophageal reflux was more common in the thoracoscopy group (OR, 2.82; 95% CI, 1.72; 4.61; p < 0.0001). Conclusion: the meta-analysis had proved that, compared to open-surgery, thoracoscopy is associated with an almost comparable rate of postoperative complications coupled with the exception of anastomotic leaks. However, it is impossible to ignore the significant advantages of the modern method for treatment of EA which is characterized - among other things - by the more rapid recovery of patients after the surgical interventions.