Right or left thoracotomy for esophageal atresia and right aortic arch? Systematic review and surgicoanatomic justification.

Autor: Mentessidou A; 1(st) Department of Pediatric Surgery, Aghia Sophia Children's Hospital, Athens, Greece; Department of Anatomy, Athens University Medical School, Athens, Greece., Avgerinos I; Department of Anatomy, Athens University Medical School, Athens, Greece., Avgerinos N; Department of Anatomy, Athens University Medical School, Athens, Greece., Skandalakis PN; Department of Anatomy, Athens University Medical School, Athens, Greece., Mirilas P; 1(st) Department of Pediatric Surgery, Aghia Sophia Children's Hospital, Athens, Greece; Department of Anatomy, Athens University Medical School, Athens, Greece. Electronic address: pmirilas@gmail.com.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2018 Nov; Vol. 53 (11), pp. 2128-2135. Date of Electronic Publication: 2018 Jun 19.
DOI: 10.1016/j.jpedsurg.2018.06.015
Abstrakt: Introduction: The optimal thoracotomy approach for the management of esophageal atresia and tracheoesophageal fistula (EA/TEF) with a right aortic arch (RAA) remains controversial.
Methods: Systematic review of complications and death rates between right- and left-sided repairs, including all studies on EA/TEF and RAA, apart from studies focusing on long-gap EA and thoracoscopic repairs. Review of right- and left-sided surgical anatomy in relation to reported complications.
Results: Although no significant differences were elicited between right- and left-sided repairs in complications (9/29 vs. 1/6, p = 0.64) and death rates (2/29 vs. 0/6, p = 0.57), unique anatomic complications - such as injury to the RAA covering the esophagus and intractable bleeding - associated with mortality were revealed in the right thoracotomy group. Left-sided repairs following failed repair through the right showed higher complications rate (3/3) than straightforward right- (9/29) or left-sided repairs (1/6) (p = 0.024). Right thoracotomies converted to left thoracotomies led to staged repairs more frequently (4/9) than straightforward right (5/38) or left thoracotomies (0/6) (p = 0.03).
Conclusions: There is not enough evidence to support that right thoracotomy, characterized by unique surgicoanatomic difficulties, is equivalent to left thoracotomy for EA/TEF with RAA. Both approaches might be required, and, therefore, surgeons should be familiarized with surgical anatomy of mediastinum approached from right and left. Systematic review, Level of Evidence III.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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