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Musculoskeletal Outcomes Following Thoracoscopic Versus Conventional Open Repair of Esophageal Atresia: A Systematic

Mustafa Azizoglu1, Sonia Perez Bertolez2, Tahsin Onat Kamci3

  • 1Istanbul Esenyurt Necmi Kadioglu State Hospital, Department of Pediatric Surgery, Istanbul, Turkey; Istinye University, Department of Stem Cell, Tissue Engineering & 3D bioprinting, Istanbul, Turkey.

Journal of Pediatric Surgery
|June 29, 2025
PubMed

Insights

Thoracoscopic repair (TR) for esophageal atresia (EA) may lead to fewer long-term musculoskeletal deformities, such as scoliosis and rib anomalies, compared to conventional open repair (COR). Further research is needed to confirm these findings due to limited data.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Orthopedic Surgery

Background:

  • Esophageal atresia (EA) repair can result in long-term thoracic musculoskeletal deformities.
  • Conventional open repair (COR) for EA is associated with potential morbidity.
  • Thoracoscopic repair (TR) is hypothesized to offer benefits over COR, including reduced musculoskeletal sequelae.

Purpose of the Study:

  • To systematically review and compare the incidence of musculoskeletal deformities after EA repair using TR versus COR.
  • To emphasize the long-term clinical implications of these deformities.

Main Methods:

  • Systematic review and meta-analysis registered on PROSPERO (CRD42024576044).
  • Comprehensive literature search across multiple databases (Ovid Medline, Cochrane, PubMed, Web of Science, EMBASE, SCOPUS, Google Scholar) up to January 2025.
  • Primary outcomes: scoliosis, rib anomalies, chest wall anomalies, and scapula alata. Statistical analysis using Review Manager (RevMan) 5.4.

Main Results:

  • Four retrospective studies with 283 patients (TR: 96; COR: 187) were included.
  • TR showed significantly lower rates of scoliosis (3.1% vs. 16%) and rib anomalies (0% vs. 41.5%) compared to COR.
  • No significant differences were found for chest wall anomalies or scapula alata. Study limitations include small sample size and methodological variability.

Conclusions:

  • Thoracoscopic repair (TR) for EA may reduce long-term musculoskeletal complications, specifically scoliosis and rib anomalies, compared to conventional open repair (COR).
  • Findings are promising but require cautious interpretation due to limited sample size and heterogeneity.
  • Multicenter studies with standardized outcomes are needed to validate these results and explore muscle-sparing techniques.
Abstract

Keywords:
Esophageal atresiaMusculoskeletal deformityRib deformityScoliosisThoracoscopy

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