Work

Efficacy and safety of internal traction in long-gap esophageal atresia: a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background: Long-gap esophageal atresia (LGEA) presents a significant surgical challenge due to the extensive gap precluding tension-free primary repair. Internal traction offers a potentially safer, esophagus-preserving alternative to external traction (Foker) techniques by avoiding prolonged sedation and ventilation. However, evidence is limited to small case series. Methods: We searched several databases, such as PubMed, Embase, and Scopus, through October 4, 2025. Eight single-arm studies (122 patients) met inclusion criteria. Pooled proportions were calculated using random-effects models with Freeman-Tukey double arcsine transformation; heterogeneity was assessed via I² statistics. Results: =21.1%), with 90% achieving full oral feeding (95% CI=58%-100%). Esophageal replacement was rare (5%) and mortality low (5%). However, morbidity was substantial: gastroesophageal reflux occurred in 73% of patients, stricture requiring dilation in 46%, postoperative stenosis in 52%, and anastomotic leak in 28%. Complication rates directly attributable to internal traction were 28%, with fundoplication required in 22% of patients. Heterogeneity was moderate to substantial for several secondary outcomes. Conclusion: Internal traction is a promising organ-preserving approach for LGEA, with high anastomotic success but substantial reflux- and stricture-related morbidity. Prospective, multicenter studies with standardized outcome definitions and comparator groups are needed to define its optimal role in LGEA management. PROSPERO registration number: CRD420251161975.

Source: World Journal of Pediatric Surgery

DOI: 10.1136/wjps-2026-001219