Purpose: 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.
Pico framework: The review included patients with long-gap esophageal atresia (LGEA) (Population); surgical interventions such as primary anastomosis, esophageal lengthening, and replacement procedures (Interventions); comparison among these techniques (Comparison); and postoperative complications and mortality as primary outcomes (Outcomes).
Methods: 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: A total of 54 studies including 1103 patients were analyzed. Pooled analyses revealed significant differences among surgical approaches in terms of major postoperative complications (p < 0.05). Open PA was associated with higher rates of anastomotic leakage and stricture, while EL showed increased rates of leakage, GERD, and re-operation. Gastric pull-up (GPU) and colonic interposition had higher rates of respiratory complications and mortality (p < 0.05). Laparoscopic GPU and jejunal interposition (JI) demonstrated comparatively lower mortality and complication rates.
Conclusion: Although all surgical techniques for LGEA carry notable morbidity, PA remains the preferred option whenever feasible, as it preserves the native esophagus. When primary repair is not possible, laparoscopic GPU and JI appear to offer the most favorable balance between functional outcomes and postoperative complications.
Other: Funding was not acquired for this study. The study was registered in the International Prospective Register of Systematic Reviews (identifier: CRD42023431955).
Type of study: Systematic review and meta-analysis.
Level of evidence: IV.
Keywords: Lengthening; Long-gap esophageal atresia; Meta-analysis; Primary repair; Replacement; Surgical outcome; Systematic review.
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