Musculoskeletal outcomes following thoracoscopic versus conventional open repair of esophageal atresia: a systematic review and meta-analysis

M Azizoğlu*, S Perez Bertolez**, TO Kamçı***, S Arslan***, MH Okur***, M Escolino****, T Erdem Şit*****, E Karakaş*****, A Mutanen******, O Muensterer*******, M Lacher********

*Istanbul Esenyurt Hospital, Department of Pediatric Surgery, Istanbul, Turkey. Istinye University, Health Science Faculty, Dep of Stem Cell and Tissue Enginering, Turkey. Pediatric Surgery Meta Analysis Study Group (PESMA)
**Pediatric Surgery Departament. Hospital Sant Joan de Déu. Barcelona. Spain. Pediatric Surgery Meta Analysis Study Group (PESMA)
***Dicle University Department of Pediatric Surgery, Diyarbakir, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
****Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy; Pediatric Surgery Meta Analysis Study Group (PESMA)
*****Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
******Department of Paediatric Surgery, The New Children's Hospital, University of Helsinki, Helsinki, Finland. Pediatric Surgery Meta Analysis Study Gorup (PESMA)
*******University Medical Center of the Johannes Gutenberg-Universität Mainz, Department of Pediatric Surgery, Germany. Pediatric Surgery Meta Analysis Study Gorup (PESMA)
********University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany. Pediatric Surgery Meta Analysis Study Gorup (PESMA)

Aim

Our aim was to assess the musculoskeletal deformity frequency after esophageal atresia (EA) repair by comparing thoracoscopy (TR) and conventional open repair (COR) techniques.

Method

The protocol of this review was prospectively registered in PROSPERO (CRD42024576044) (http://www.crd.york.ac.uk/PROSPERO/). We conducted a comprehensive literature search using several databases, including Ovid Medline, Cochrane, PubMed, Web of Sciences, EMBASE, and SCOPUS until August 2024. We calculated rates of Scoliosis, rib deformity, rib adhesions, chest wall anomaly, and winging of scapula. Review Manager (RevMan) software, version 5.4 was used for analysis.

Results

A total of 4 studies comparing TR (n=96) to COR (n=187) were included in the meta-analysis. TR group had a significantly lower scoliosis rate compared to COR (I²=36%) (RR:0.35, 95%CI: 0.14-0.84; p=0.02). The overall scoliosis rates in the TR and COR groups were 3.1% and 16%, respectively. TR group had a significantly lower rib deformity rates compared to COR (I²=0%) (RR:0.05, 95%CI: 0.01-0.25; p=0.0002). The overall rib deformity rates in the TR and COR groups were 0% and 41.5%, respectively. No difference was found between groups regarding rib adhesion rate (RR:0.16, 95%CI: 0.01-2.52; p=0.19), chest wall anomaly rate (I²=54%) (RR:0.65, 95%CI: 0.23-1.81; p=0.41), and scapula alata rate (RR:0.37, 95%CI: 0.05-2.46; p=0.30).

Conclusion

TR of EA seems to offer significant advantages over COR in reducing the incidence of musculoskeletal outcomes.

Keywords: Musculoskeletal deformity, scoliosis, rib deformity, Esophageal atresia, thoracoscopy

Özofagus atrezisinin torakoskopik ve açık onarımı sonrası kas-iskelet sistem deformiteleri sonuçları: bir sistematik inceleme ve meta-analiz

M Azizoğlu*, S Perez Bertolez**, TO Kamçı***, S Arslan***, MH Okur***, M Escolino****, T Erdem Şit*****, E Karakaş*****, A Mutanen******, O Muensterer*******, M Lacher********

*Istanbul Esenyurt Hospital, Department of Pediatric Surgery, Istanbul, Turkey. Istinye University Health Science Faculty, Department of Stem Cell and Tissue Engineering, Istanbul, Turkey. Pediatric Surgery Meta Analysis Study Group (PESMA)
**Pediatric Surgery Departament. Hospital Sant Joan de Déu. Barcelona. Spain. Pediatric Surgery Meta Analysis Study Group (PESMA)
***Dicle University Department of Pediatric Surgery, Diyarbakir, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
****Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy; Pediatric Surgery Meta Analysis Study Group (PESMA)
*****Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
******Department of Paediatric Surgery, The New Children's Hospital, University of Helsinki, Helsinki, Finland. Pediatric Surgery Meta Analysis Study Gorup (PESMA)
*******University Medical Center of the Johannes Gutenberg-Universität Mainz, Department of Pediatric Surgery, Germany. Pediatric Surgery Meta Analysis Study Gorup (PESMA)
********University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany. Pediatric Surgery Meta Analysis Study Gorup (PESMA)

Amaç

Amacımız, özofagus atrezisi (EA) onarımından sonra torakoskopi (TR) ve geleneksel açık onarım (COR) tekniklerini karşılaştırarak kas-iskelet deformitesi sıklığını değerlendirmekti.

Yöntem

Bu incelemenin protokolü PROSPERO'da (CRD42024576044) (http://www.crd.york.ac.uk/PROSPERO/) prospektif olarak kaydedildi. Ağustos 2024'e kadar Ovid Medline, Cochrane, PubMed, Web of Sciences, EMBASE ve SCOPUS gibi çeşitli veritabanları kullanılarak kapsamlı bir literatür taraması yapıldı. Skolyoz, kot deformitesi, kkot yapışıklığı, göğüs duvarı anomalisi ve scapula alata oranları hesaplandı. Analizler için Review Manager (RevMan) yazılımı, sürüm 5.4 kullanıldı.

Bulgular

TR (n=96) ile COR (n=187) tekniklerini karşılaştıran toplam 4 çalışma meta-analize dahil edildi. TR grubunun, COR grubuna kıyasla skolyoz oranı anlamlı olarak daha düşüktü (I²=36%) (RR:0.35, 95%CI: 0.14-0.84; p=0.02). TR ve COR gruplarındaki genel skolyoz oranları sırasıyla %3.1 ve %16 olarak bulundu. TR grubunun, COR grubuna kıyasla kot deformitesi oranı anlamlı olarak daha düşüktü (I²=0%) (RR:0.05, 95%CI: 0.01-0.25; p=0.0002). TR ve COR gruplarındaki genel kaburga deformitesi oranları sırasıyla %0 ve %41.5 olarak bulundu. Gruplar arasında kot yapışıklığı oranı (RR:0.16, 95%CI: 0.01-2.52; p=0.19), göğüs duvarı anomalisi oranı (I²=54%) (RR:0.65, 95%CI: 0.23-1.81; p=0.41) ve scapula alata oranı (RR:0.37, 95%CI: 0.05-2.46; p=0.30) açısından fark bulunmadı.

Sonuç

EA’nın TR yöntemi, kas-iskelet sonuçlarının insidansını azaltmada COR yöntemine göre önemli avantajlar sunuyor gibi görünmektedir.

Anahtar Kelimeler: Kas-iskelet deformitesi, skolyoz, kaburga deformitesi, özofagus atrezisi, torakoskopi