title: Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula repair: review of the literature and meta-analysis.
abstract: BACKGROUND
  The thoracoscopic approach to esophageal atresia (EA) with tracheoesophageal fistula (TOF) represents a challenging procedure whose real benefits remains unclear. Our purpose is to identify, through a meta-analysis, clinical evidence of the reliability of the thoracoscopic repair (TR) for EA/TOF compared with the open repair.
  
  
  METHODS
  Defined PubMed search, with analysis of intraoperative and postoperative complications after open or thoracoscopic primary anastomosis for EA/TOF.
  
  
  RESULTS
  Five articles met the criteria of meta-analysis, being comparative studies between TR and conventional open repair (COR), although they were retrospective. One article was excluded because it was available only in Japanese. We observed a slight prevalence, statistically insignificant, of the intraoperative and postoperative complication rate for TR: odds ratio (OR) 1.29. Excluding the conversion rate, the meta-analysis between the complication rate for TR and COR did not show a significant difference (OR 0.64). Anastomosis's leaks and strictures considered together did not show a significant difference between the two techniques, p = not significant and OR of 0.56. Similar results were observed analyzing the single outcome of leaks and strictures; the meta-analysis did not show any significant differences with an OR, respectively, of 1.05 and 0.43.
  
  
  CONCLUSIONS
  The effectiveness of the endoscopic technique for EA/TOF repair is indicated with outcomes not different from open surgery. A randomized controlled trial is needed in this field to indicate which procedure is superior, open or TR.
authors.affiliation: Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy. francesca.borruto@virgilio.it
authors.forename: Francesca Astra
authors.initials: FA
authors.lastname: Borruto
authors.forename: Pietro
authors.initials: P
authors.lastname: Impellizzeri
authors.forename: Angela Simona
authors.initials: AS
authors.lastname: Montalto
authors.forename: Pietro
authors.initials: P
authors.lastname: Antonuccio
authors.forename: Emanuela
authors.initials: E
authors.lastname: Santacaterina
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scalfari
authors.forename: Francesco
authors.initials: F
authors.lastname: Arena
authors.forename: Carmelo
authors.initials: C
authors.lastname: Romeo
mesh_terms: D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D008297:Male; D011183:Postoperative Complications; D013906:Thoracoscopy; D013908:Thoracotomy; D014138:Tracheoesophageal Fistula / Q000151:congenital / Q000601:surgery*; D016896:Treatment Outcome