Τίτλος:
Right or left thoracotomy for esophageal atresia and right aortic arch?
Systematic review and surgicoanatomic justification
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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. (C) 2018
Elsevier Inc. All rights reserved.
Συγγραφείς:
Mentessidou, Anastasia
Avgerinos, Ilias
Avgerinos, Nikolaos and
Skandalakis, Panagiotis N.
Mirilas, Petros
Περιοδικό:
Journal of Pediatric Surgery
Εκδότης:
W B SAUNDERS CO-ELSEVIER INC
Λέξεις-κλειδιά:
Esophageal atresia and tracheoesophageal fistula; Left thoracotomy;
Right aortic arch; Right thoracotomy; Surgical anatomy of mediastinum;
Systematic review
DOI:
10.1016/j.jpedsurg.2018.06.015
