Pediatric Surgery International

, Volume 35, Issue 1, pp 87–95 | Cite as

Post-operative paralysis and elective ventilation reduces anastomotic complications in esophageal atresia: a systematic review and meta-analysis

  • Joshua S. O’Connell
  • Maarten Janssen Lok
  • Hiromu Miyake
  • Shogo Seo
  • Edoardo Bindi
  • Mashriq Alganabi
  • Agostino PierroEmail author
Original Article


Aim of study

The repair of esophageal atresia (EA) carries an increased risk of anastomotic leak and stricture formation, especially in patients with anastomotic tension. To minimize this risk, pediatric surgeons perform elective post-operative muscle paralysis, positive-pressure ventilation, and head flexion (PVF) to reduce movement and tension at the anastomosis. We systematically reviewed and analyzed the effect of post-operative PVF on reducing anastomotic complications.


Embase, MEDLINE, Web of Science, and PubMed databases were used to conduct searches. Articles reporting pediatric EA undergoing primary anastomosis, anastomotic complications, and comparisons between patients who received post-operative PVF to those who did not were included. Odds ratios (OR) for all post-operative anastomotic complications were calculated using random effects modelling.

Main results

Three of the 2268 papers retrieved met inclusion criteria (all retrospective cohort studies). There were no randomized controlled trials. Post-operative PVF showed a significant reduction in anastomotic leak (OR 0.07; 95% CI 0.01–0.35) when compared to no PVF. Stricture formation was not statistically different between groups. Potential sources of bias include patient allocation.


Based on available data, our analysis indicates PVF may reduce anastomotic post-operative leak. To confirm these results, a prospective study with clearer definitions of treatment allocation should be performed.


Pediatric surgery Esophageal atresia  Primary anastomosis Endotracheal intubation Mechanical ventilation Muscle paralysis 



Dr. Agostino Pierro was supported by the endowment of the Robert M. Filler Chair of Surgery and The Hospital for Sick Children. Dr. O’Connell would like to thank Dr. Nunes for the support through the writing of this article.


Robert M. Filler Chair of Surgery, The Hospital for Sick Children.

Compliance with ethical standards

Financial disclosure

The authors have no conflicts of interest to disclose.

Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Joshua S. O’Connell
    • 1
    • 2
  • Maarten Janssen Lok
    • 1
    • 2
  • Hiromu Miyake
    • 1
    • 2
  • Shogo Seo
    • 1
    • 2
  • Edoardo Bindi
    • 1
    • 2
  • Mashriq Alganabi
    • 1
    • 2
  • Agostino Pierro
    • 1
    • 2
    Email author
  1. 1.Division of General and Thoracic SurgeryThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoCanada

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