The Left-Sided Repair: An Alternative Approach for Difficult Esophageal Atresia Repair
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Read the article on jpedsurg.org ↗Article · Nov 2020 · 1 min read
In brief
In brief
Left-sided surgical approach for long gap esophageal atresia repair offers comparable outcomes to traditional right-sided technique, with advantages including reduced paralysis duration when using internal traction and no tracheomalacia interventions required. Study of 47 patients demonstrates this approach is viable for cases with leftward upper pouch anatomy or as salvage after failed right-sided attempts.
Written by the GCMD Library team from the article.
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.