Whether prophylactic intraoperative chest drain insertion in esophageal atresia-tracheoesophageal fistula is an evidence-based practice or just a prejudice: A systematic review and meta-analysis


      • Although practiced by >50% of the Pediatric Surgeons, prophylactic intraoperative chest drain insertion in esophageal atresia-tracheoesophageal fistula is a debatable practice that lacks a concrete evidence
      • There is no additional benefit of chest drain insertion during surgical repair of EA-TEF in terms of requirement of chest drain in the postoperative period, incidence of postoperative complications, revisits to the operating room, and mortality.



      Various controversial practices in the management of Esophageal atresia-tracheoesophageal fistula (EA-TEF) can be noticed among pediatric surgeons. Routine intraoperative chest drain (IOCD) insertion is often debated and lacks any concrete evidence. This meta-analysis aims to compare the postoperative outcomes among newborns with and without IOCD insertion.


      The authors searched EMBASE, PubMed, Scopus, and Web of Science on 30th April 2021. The requirement for chest drain in the postoperative period (POCD), anastomotic leak (and/or pneumothorax), mortality rate, and revisit(s) to the operation room (RVOR) were compared among two groups of newborns, i.e. groups A and B with and without IOCD insertion respectively. The statistical analysis was performed using a fixed-effects model. The pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale.


      A total of 498 newborns were included in the present analysis. As compared to group B, newborns within group A showed no significant difference in the requirement for POCD (RR 2.47; 95% CI 0.88–6.98, p = 0.09), the occurrence of anastomotic leak and/or pneumothorax (RR 1.35; 95% CI 0.89–2.06, p = 0.16), and mortality rate (RR 2.24; 95% CI 0.81–6.26, p = 0.12). However, RVOR was significantly higher in group A (RR 1.75; 95% CI 1.07–2.87, p = 0.03). All included studies had a moderate risk of bias.


      The present meta-analysis revealed no additional benefit of prophylactic IOCD insertion. However, due to moderate risk of bias, further studies need to be conducted for an optimal comparison between the two groups.



      EA-TEF (Esophageal atresia-Tracheoesophageal fistula), IOCD (Intraoperative chest drain), POCD (Postoperative chest drain), RVOR (Revisit(s) to the operation room), RR (Pooled risk ratio), LOS (Length of stay)
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