Stented versus Non-Stented Endoscopic Transnasal Repair of Pediatric Choanal Atresia: A Systematic Review of Surgical Outcomes and Restenosis Risk

Choanal Atresia (CA) is a rare congenital condition with variable surgical management in pediatric populations, and the role of postoperative stenting remains controversial. This systematic review aimed to compare surgical outcomes and restenosis risk between stented and non-stented endoscopic transnasal repair in children with CA. The review was conducted in accordance with PRISMA guidelines, with searches of PubMed, CINAHL, Scopus, Cochrane Library, and Web of Science through February 2026. The primary comparison was restricted to studies that directly evaluated both stented and non-stented groups; single-arm studies were considered indirect supportive evidence. Twelve studies involving 376 patients were included. Restenosis and patency outcomes varied substantially across studies, and direct comparative studies did not show a uniform direction or magnitude of benefit from either approach. Several comparative studies reported higher restenosis with stenting, whereas other studies showed substantial restenosis in non-stented groups. Differences in mucosal-flap technique, vomer resection, postoperative care, stent material and duration, and patient severity may have contributed to the observed heterogeneity. Overall, Reported restenosis rates varied substantially across studies and between treatment groups. Comparative studies generally suggested a higher risk of restenosis with stenting, but the magnitude of this difference was inconsistent, and some studies reported substantial restenosis in both stented and non-stented groups. Therefore, the reported ranges should not be interpreted as uniformly representative of all included studies.