title: Long-gap esophageal atresia: a meta-analysis of jejunal interposition, colon interposition, and gastric pull-up.
abstract: OBJECTIVE
  There is still no consensus about the optimal surgical approach for esophageal replacement in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures. The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU).
  
  
  METHODS
  Review of the English-language literature published in the past 5 years about esophageal replacement in children was done. The focus was on postoperative survival rate, morbidity (gastrointestinal complications such as anastomotic stenosis/leakage and respiratory complications such as pneumothorax, pneumonia, and atelectasis), and long-term follow-up when available. Among long-term gastrointestinal outcomes were dysphagia, reflux, and dumping; among long-term respiratory outcomes were recurrent pneumonia and recurrent aspiration leading to chronic lung disease. Data were computed by Comprehensive Meta-Analysis software (Version 2.2.064).
  
  
  RESULTS
  A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective) including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI, 99 (21%) GPU, and 27 (6%) JI. Among these 15 studies, 9 provided data about long-term follow-up.
  
  
  CONCLUSIONS
  Proper prospective comparative studies are lacking. GPU and CI appear comparable regarding postoperative mortality, anastomotic complications, and graft loss. On the long-term, GPU seems to be associated with a higher respiratory morbidity but fewer gastrointestinal complications than CI. Based on this article only two series provide data about JI, and they show highly divergent results. JI appears to be a valid replacement technique when performed by experienced centers; however larger numbers are needed to assess the outcomes of this procedure.
authors.affiliation: Department of Paediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands. g.gallo@umcg.nl
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gallo
authors.forename: Sander
authors.initials: S
authors.lastname: Zwaveling
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.forename: David
authors.initials: D
authors.lastname: Van der Zee
authors.forename: Jan
authors.initials: J
authors.lastname: Hulscher
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002648:Child; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications