Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis.

Transnasal endoscopic approach for the repair of choanal atresia (CA) has gained favor in recent years. However, the studied cohorts are too small to make a comprehensive comment on this approach. The aim of this study was to evaluate the effects of different techniques, used for the removal of CA under endoscopic guidance, on surgical outcome and effectiveness of transnasal endoscopic approach in these patients as a whole. We present the results of transnasal endoscopic repair of CA in 13 patients and made a meta-analysis of similar studies in the literature. Mean success rate with transnasal endoscopic repair was 85.3% in a total of 238 cases in 20 studies that met the inclusion criteria. Only the history of previous surgery for CA seemed to significantly decrease the postoperative success rate (P = 0.029). Rate of revision surgery did not significantly differ between mixed, bony, or membranous atresia (P = 0.395). Likewise, simple perforation or complete excision of the atretic plate under endoscopic view (P = 0.513), use or no use of mucosal flap to seal the denuded bone of the choana (P = 0.472), and postoperative stenting or no stenting (P = 0.252) have proved not to considerably have influence on the surgical outcome. Death of perioperative bleeding was the single major complication in 1 case among all of the study groups. In conclusion, types of CA, excision method, and stenting have no significant effect on surgical outcome of CA. Irrespective of the technique used for the excision and the repair of atretic plate, transnasal endoscopic approach with higher success rate and minimal postoperative morbidity is a good choice for the repair of CA.