Advertisement

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

      Highlights

      • 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.

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

      Abbreviations:

      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)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Al-Salem AH
        • Qaisaruddin S
        • Srair HA
        • et al.
        Elective, postoperative ventilation in the management of esophageal atresia and tracheoesophageal fistula.
        Pediatr Surg Int. 1997; 12: 261-263
        • Zani A
        • Eaton S
        • Hoellwarth ME
        • et al.
        International survey on the management of esophageal atresia.
        Eur J Pediatr Surg. 2014; 24: 3-8
        • Donnelly LF
        • Frush DP
        Bisset GS 3rd. the appearance and significance of extra-pleural fluid after esophageal atresia repair.
        AJR Am J Roentgenol. 1999; 172: 231-233
        • McCallion WA
        • Hannon RJ
        • Boston VE.
        Prophylactic extrapleural chest drainage following repair of esophageal atresia: is it necessary?.
        J Pediatr Surg. 1992; 27: 561
        • Nguyen MVL
        • Delaplain PT
        • Lim JC
        • et al.
        The value of prophylactic chest tubes in tracheoesophageal fistula repair.
        Pediatr Surg Int. 2020; 36: 687-696
        • Gawad N
        • Wayne C
        • Bass J
        • et al.
        A chest tube may not be needed after surgical repair of esophageal atresia and tracheoesophageal fistula.
        Pediatr Surg Int. 2018; 34: 967-970
        • Aslanabadi S
        • Jamshidi M
        • Tubbs RS
        • et al.
        The role of prophylactic chest drainage in the operative management of esophageal atresia with tracheoesophageal fistula.
        Pediatr Surg Int. 2009; 25: 365-368
        • Paramalingam S
        • Burge DM
        • Stanton MP.
        Operative intercostal chest drain is not required following extrapleural or transpleural esophageal atresia repair.
        Eur J Pediatr Surg. 2013; 23: 273-275
        • Sharma S
        • Pathak S
        • Ayanat H
        • et al.
        Retropleural drainage: yes or no in primary repair of esophageal atresia with Tracheoesophageal Fistula.
        Int J Contemp Med Res. 2016; 3: 1623-1625
        • Gangopadhyay AN
        • Apte AV
        • Kumar V
        • et al.
        Is Retropleural drainage necessary after definitive repair of esophageal atresia and Tracheoesophageal Fistula?.
        J Indian Assoc Pediatr Surg. 2003; 8: 86-90
        • Downs SH
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
        J Epidemiol Commun Health. 1998; 52: 377-384
        • Landis JR
        • Koch GG.
        The measurement of observer agreement for categorical data.
        Biometrics. 1997; 33: 159-174
      1. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) Cochrane handbook for systematic reviews of interventions version 6.2 (updated February 2021). Cochrane. Available from http://www.training.cochrane.org/handbook. Accessed 06 May 2021

        • Cui X
        • He Y
        • Chen L
        • et al.
        The value of thoracic lavage in the treatment of anastomotic leakage after surgery for type III Esophageal Atresia.
        Med Sci Monit. 2020; 26e919962
        • Asban A
        • Xie R
        • Abraham P
        • et al.
        Reasons for extended length of stay following chest tube removal in general thoracic surgical patients.
        J Thorac Dis. 2020; 12: 5700-5708
        • Kay S
        • Shaw K.
        Revisiting the role of routine retropleural drainage after repair of esophageal atresia with distal tracheoesophageal fistula.
        J Pediatr Surg. 1999; 34: 1082-1085
        • Haight C.
        Congenital Atresia of the Esophagus With Tracheoesophageal Fistula: reconstruction of esophageal continuity by primary anastomosis.
        Ann Surg. 1944; 120: 623-652
        • Pinheiro PF
        • Simões e Silva AC
        • Pereira RM.
        Current knowledge on esophageal atresia.
        World J Gastroenterol. 2012; 18: 3662-3672
        • Burge DM
        • Shah K
        • Spark P
        • et al.
        Contemporary management and outcomes for infants born with oesophageal atresia.
        Br J Surg. 2013; 100: 515-521
        • Manning PB
        • Morgan RA
        • Coran AG
        • et al.
        Fifty years' experience with esophageal atresia and tracheoesophageal fistula. Beginning with Cameron Haight's first operation in 1935.
        Ann Surg. 1986; 204: 446-453
        • Okata Y
        • Maeda K
        • Bitoh Y
        • et al.
        Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula.
        Pediatr Surg Int. 2016; 32: 869-873
        • Dey S
        • Jain V
        • Anand S
        • et al.
        First-year follow-up of newborns operated for Esophageal Atresia in a developing Country: just operating is not enough!.
        J Indian Assoc Pediatr Surg. 2020; 25: 206-212