TY - JOUR
T1 - The left-sided repair
T2 - An alternative approach for difficult esophageal atresia repair
AU - Jo Svetanoff, Wendy
AU - Zendejas, Benjamin
AU - Ngo, Peter
AU - Manfredi, Michael
AU - Hamilton, Thomas E.
AU - Jennings, Russell W.
AU - Smithers, C. Jason
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/5
Y1 - 2021/5
N2 - Purpose: : We describe a left-sided approach for long gap esophageal atresia (LGEA) repair in patients who have a large leftward upper pouch and no significant tracheomalacia, or as a salvage strategy after prior failed right-sided repairs. Methods: : Retrospective review of patients who underwent repair via traction induced growth (Foker procedure [FP]) from 2014 to 2019 was performed. Surgical technique and post-operative outcomes were evaluated. Results: : Of 47 LGEA patients, 18 (38%) were approached via the left side – 94% had a left aortic arch, and 22% had prior attempts at a right-sided anastomosis. More left-sided patients underwent minimally invasive repair (39% vs 7%, p = 0.007) and internal traction (50% vs 10%, p = 0.002) compared to right-sided patients. On multivariate analysis, internal traction was associated with a decreased length of paralysis (p<0.01); length of intubation and hospital stay were similar between groups. Anastomotic leak (17% vs 20%, p = 0.80) and stricture resection (6% vs 24%, p = 0.12) rates were similar. No left-sided FP patient required additional surgery for tracheomalacia, while six right-sided patients required intervention. Conclusion: : Left-sided FP can be considered for LGEA patients with a large leftward upper pouch or as a salvage pathway after a failed right chest approach, with similar outcomes to the right-sided approach.
AB - Purpose: : We describe a left-sided approach for long gap esophageal atresia (LGEA) repair in patients who have a large leftward upper pouch and no significant tracheomalacia, or as a salvage strategy after prior failed right-sided repairs. Methods: : Retrospective review of patients who underwent repair via traction induced growth (Foker procedure [FP]) from 2014 to 2019 was performed. Surgical technique and post-operative outcomes were evaluated. Results: : Of 47 LGEA patients, 18 (38%) were approached via the left side – 94% had a left aortic arch, and 22% had prior attempts at a right-sided anastomosis. More left-sided patients underwent minimally invasive repair (39% vs 7%, p = 0.007) and internal traction (50% vs 10%, p = 0.002) compared to right-sided patients. On multivariate analysis, internal traction was associated with a decreased length of paralysis (p<0.01); length of intubation and hospital stay were similar between groups. Anastomotic leak (17% vs 20%, p = 0.80) and stricture resection (6% vs 24%, p = 0.12) rates were similar. No left-sided FP patient required additional surgery for tracheomalacia, while six right-sided patients required intervention. Conclusion: : Left-sided FP can be considered for LGEA patients with a large leftward upper pouch or as a salvage pathway after a failed right chest approach, with similar outcomes to the right-sided approach.
KW - Esophageal atresia
KW - Foker procedure
KW - Internal traction
KW - Left-sided approach
KW - Long gap esophageal atresia
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U2 - 10.1016/j.jpedsurg.2020.11.003
DO - 10.1016/j.jpedsurg.2020.11.003
M3 - Article
C2 - 33248682
AN - SCOPUS:85097111213
SN - 0022-3468
VL - 56
SP - 938
EP - 943
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 5
ER -