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 accessOne-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 SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Elective, postoperative ventilation in the management of esophageal atresia and tracheoesophageal fistula.Pediatr Surg Int. 1997; 12: 261-263
- International survey on the management of esophageal atresia.Eur J Pediatr Surg. 2014; 24: 3-8
- Bisset GS 3rd. the appearance and significance of extra-pleural fluid after esophageal atresia repair.AJR Am J Roentgenol. 1999; 172: 231-233
- Prophylactic extrapleural chest drainage following repair of esophageal atresia: is it necessary?.J Pediatr Surg. 1992; 27: 561
- The value of prophylactic chest tubes in tracheoesophageal fistula repair.Pediatr Surg Int. 2020; 36: 687-696
- A chest tube may not be needed after surgical repair of esophageal atresia and tracheoesophageal fistula.Pediatr Surg Int. 2018; 34: 967-970
- The role of prophylactic chest drainage in the operative management of esophageal atresia with tracheoesophageal fistula.Pediatr Surg Int. 2009; 25: 365-368
- Operative intercostal chest drain is not required following extrapleural or transpleural esophageal atresia repair.Eur J Pediatr Surg. 2013; 23: 273-275
- Retropleural drainage: yes or no in primary repair of esophageal atresia with Tracheoesophageal Fistula.Int J Contemp Med Res. 2016; 3: 1623-1625
- Is Retropleural drainage necessary after definitive repair of esophageal atresia and Tracheoesophageal Fistula?.J Indian Assoc Pediatr Surg. 2003; 8: 86-90
- 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
- The measurement of observer agreement for categorical data.Biometrics. 1997; 33: 159-174
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
- The value of thoracic lavage in the treatment of anastomotic leakage after surgery for type III Esophageal Atresia.Med Sci Monit. 2020; 26e919962
- Reasons for extended length of stay following chest tube removal in general thoracic surgical patients.J Thorac Dis. 2020; 12: 5700-5708
- Revisiting the role of routine retropleural drainage after repair of esophageal atresia with distal tracheoesophageal fistula.J Pediatr Surg. 1999; 34: 1082-1085
- Congenital Atresia of the Esophagus With Tracheoesophageal Fistula: reconstruction of esophageal continuity by primary anastomosis.Ann Surg. 1944; 120: 623-652
- Current knowledge on esophageal atresia.World J Gastroenterol. 2012; 18: 3662-3672
- Contemporary management and outcomes for infants born with oesophageal atresia.Br J Surg. 2013; 100: 515-521
- Fifty years' experience with esophageal atresia and tracheoesophageal fistula. Beginning with Cameron Haight's first operation in 1935.Ann Surg. 1986; 204: 446-453
- 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
- 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
Article info
Publication history
Published online: July 07, 2021
Accepted:
June 29,
2021
Received in revised form:
June 25,
2021
Received:
May 18,
2021
Footnotes
Category of Manuscript: Systematic Review and Meta-analysis
Funding: None
Conflict of interests: None
Type of Study: Systematic Review and Meta-analysis
Level of Evidence: Level III
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
