Nerve injury and vocal cord paralysis after esophageal atresia and tracheoesophageal fistula repair: Systematic review and meta-analysis

Aim: Vocal cord paralysis (VCP) and recurrent laryngeal nerve injury may be either congenital or acquired due to surgical trauma in patients with esophageal atresia and tracheoesophageal fistula (EA-TEF). A systematic review and meta-analysis were performed to define the risk factors for developing VCP and other nerve injuries. Methods: Systematic literature search was conducted for the period 2000 (Jan) to 2024 (Jan) under the PRISMA guidelines. The study protocol was registered on PROSPERO (CRD42024532277). EMBASE, MEDLINE and PUBMED databases were searched and qualitative and quantitative data were extracted relating to VCP, recurrent laryngeal and phrenic nerve injury in patients with EA-TEF. Statistical analysis was performed with CMA-V4 software. Results: Among 1421 articles, 851 abstracts were screened for inclusion criteria. Full texts of 125 articles were assessed for eligibility. The subgroup analysis was performed in 8 articles for type of EA-TEF and 4 articles for type of surgery. The risk of VCP occurrence was increased 1.58 times in Type-A, 2.97 times in Type-B and 6.85 times in Type -E when compared to Type-C EA [95%CI: (0.95–2.63, p = 0.08), (0.96–9.17, p = 0.059), (3.23–14.52, p < 0,05), respectively]. There was no significant correlation between thoracotomy and thoracoscopy to risk of VCP occurrence [OR:1.85 (95 % CI 0.42–8.04), p = 0.41]. Kendal's Tau test and Egger's tests were performed revealing that there was no publication bias for all data. Conclusions: Although the risk of vocal cord paralysis was higher in other EA types compared to type C, a statistically significant difference was observed only between type C and type E. The surgical approach, whether thoracotomy or thoracoscopic, does not appear to be associated with the risk of vocal cord paralysis.