Surgical Versus Non-Surgical Treatment for Traumatic Esophageal Perforation in Children: A Systematic Review

Abstract

The study design of this paper is a systematic review of literature published in the recent 10 years. Esophageal perforations in children have long been a topic of debate. The management protocols are chiefly governed by symptom severity, perforation site, time elapsed since perforation and cause of perforation. Esophageal perforations in pediatric group of patients can be iatrogenic or traumatic. The aim to conduct the study was to assess the benefits and timely management of surgical versus non-surgical treatment for pediatric patients with traumatic esophageal perforation. The two research questions below were determined. We systematically reviewed retrospective serial studies assessing the medical treatment compared to the surgical interventions for the traumatic esophageal perforation in children. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects, as well as foreign literature with English translations. No randomized controlled trial studies had been conducted in children with esophageal perforation. Information on patients’ age, comorbidities, methods of treatment, and effects on mortality, morbidity were extracted. Three independent reviewers selected the articles for analysis after screening the titles, abstracts, and full texts, then extracted data and graded the quality of each paper according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Specific clinical questions were as follows. 1) In patients with early diagnosis of esophageal perforation, what are the indications for treatment (surgery versus conservative management) and its impact on prognosis? 2) In patients with delayed diagnosis, what are the indications for treatment (surgery versus conservative management) and its impact on mortality and morbidity rate? A total of 66 abstracts were identified using various keywords. Nine retrospective articles (level III) were eligible for inclusion, involving a total of 77 cases of esophageal perforation in pediatric patients. Non-operative management is recommended for perforations diagnosed within 24 - 48 hours in a stable patient with contained leakage, but hemodynamically unstable patients with a contained perforation, ongoing leakage and early diagnosed have a higher chance of successful primary repair, whereas delayed ones require conservative treatment. J Curr Surg. 2016;6(2):41-45 doi: http://dx.doi.org/10.14740/jcs296w