Minimally Invasive Esophageal Replacement in Children: A Systematic Review and Meta-analysis.

BACKGROUND/PURPOSE: Esophageal replacement in children is traditionally performed through open thoraco-abdominal approaches. Minimally invasive surgery (MIS) is increasingly used in selected pediatric centers, but experience remains fragmented across small series. We pooled the available evidence to quantify the safety and efficacy of pediatric MIS esophageal replacement. METHODS: This PRISMA 2020-compliant review searched PubMed, Scopus and Web of Science from inception to 31 August 2025. Two reviewers independently screened records, extracted data, and assessed quality using the Methodological Index for Non-Randomized Studies (MINORS). Pooled rates and means were calculated under random-effects models in Comprehensive Meta-Analysis v3.3. RESULTS: Twelve studies (159 children, 2007-2024) were included. Mean age at surgery was 25.2 months; main indications were long-gap esophageal atresia (65.9%) and caustic injury (33.5%); a whole-stomach conduit was used in 88.9%. Pooled operative time was 283.5 minutes. Conversion to open occurred in 9.4%; anastomotic leak in 16.1% (concentrated in gastric-tube conduits); stricture in 31.3%; and recurrent-laryngeal-nerve palsy in 9.3%. One 30-day procedure-related death was reported (0.6%; 95% CI 0.02-3.45%). At a mean follow-up of 41.7 months, 75.1% achieved full or predominantly oral feeds. CONCLUSIONS: In experienced centers, pediatric laparoscopic esophageal replacement appears feasible, with low 30-day mortality and infrequent conversion; anastomotic stricture is the main morbidity. The limited, mostly retrospective evidence warrants cautious interpretation and prospective multicenter study. LEVEL OF EVIDENCE: IV (systematic review of retrospective and observational studies).