AUTHOR=Ladefoged Martin Riis , Korang Steven Kwasi , Hildorf Simone Engmann , Oehlenschlæger Jacob , Poulsen Susanne , Fossum Magdalena , Lausten-Thomsen Ulrik TITLE=Necessity of Prophylactic Extrapleural Chest Tube During Primary Surgical Repair of Esophageal Atresia: A Systematic Review and Meta-Analysis JOURNAL=Frontiers in Pediatrics VOLUME=10 YEAR=2022 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.849992 DOI=10.3389/fped.2022.849992 ISSN=2296-2360 ABSTRACT=Background

Esophageal atresia is corrected surgically by anastomosing and recreating esophageal continuity. To allow the removal of excess fluid and air from the anastomosis, a prophylactic and temporary intraoperative chest tube (IOCT) has traditionally been placed in this area during surgery. However, whether the potential benefits of this prophylactic IOCT overweigh the potential harms is unclear.

Objective

To assess the benefits and harms of using a prophylactic IOCT during primary surgical repair of esophageal atresia.

Data Sources

We conducted a systematic review with a meta-analysis. We searched Cochrane Central Register of Controlled Trials (2021, Issue 12), MEDLINE Ovid, Embase Ovid, CINAHL, and Science Citation Index Expanded and Conference Proceedings Citation Index—(Web of Science). Search was performed from inception until December 3rd, 2021.

Study Selection

Randomized clinical trials (RCT) assessing the effect of a prophylactic IOCT during primary surgical repair of esophageal atresia and observational studies identified during our searches for RCT.

Data Extraction and Synthesis

Two independent reviewers screened studies and performed data extraction. The certainty of the evidence was assessed by GRADE and ROBINS-I.

PROSPERO Registration

A protocol for this review has been registered on PROSPERO (CRD42021257834).

Results

We included three RCTs randomizing 162 neonates, all at overall “some risk of bias.” The studies compared the placement of an IOCT vs. none. The meta-analysis did not identify any significant effect of profylacitic IOCT, as confidence intervals were compatible with no effect, but the analyses suggests that the placement of an IOCT might lead to an increase in all-cause mortality (RR 1.66, 95% CI 0.76–3.65; three trials), serious adverse events (RR 1.08, 95% CI 0.58–2.00; three trials), intervention-requiring pneumothorax (RR 1.65, 95% CI 0.28–9.50; two trials), and anastomosis leakage (RR 1.66, 95% CI 0.63–4.40). None of our included studies assessed esophageal stricture or pain. Certainty of evidence was very low for all outcomes.

Conclusions

Evidence from RCTs does not support the routine use of a prophylactic IOCT during primary surgical repair of esophageal atresia.