The left-sided repair: An alternative approach for difficult esophageal atresia repair

Wendy Jo Svetanoff, Benjamin Zendejas, Peter Ngo, Michael Manfredi, Thomas E. Hamilton, Russell W. Jennings, C. Jason Smithers

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • Esophageal atresia
  • Foker procedure
  • Internal traction
  • Left-sided approach
  • Long gap esophageal atresia

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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