Right thoracotomy approach for patients with congenital tracheoesophageal fistula associated with right-sided aortic arch: a multicentric study

Abstract

Background: A right-sided aortic arch (RAA) occurs in 5% of patients with esophageal atresia (EA). Its presence has significant surgical implications. Repair of the atresia has been considered difficult with the usual approach through the right chest. We hereby report our experience with cases of EA and RAA treated over the past 13 years in three pediatric surgical departments to determine the optimal surgical approach.

Patients and methods: This is a retrospective study, which included all patients having EA with tracheoesophageal fistulas (TEFs) treated between January 2000 and September 2013 at four pediatric surgery departments (Zagazig University Hospital, Egypt; Assir Central Hospital, Kingdom of Saudi Arabia; MCH Najran, Kingdom of Saudi Arabia; Soba University Hospital, Sudan). The study compared a group of 22 patients who had EA with TEFs with RAA and no associated congenital disorder with another group of 22 patients who had the same condition but with normally situated left-sided aortic arch.

Results: A total of 44 patients having EA with fistula were included into this study. They were divided into two groups on the basis of the side of aortic arch; 22 patients had leftsided aortic arch (group L), and the other 22 patients had RAA (group R). All patients were treated through right  thoracotomy. It was possible to achieve successful, although difficult management, in all patients with RAA through right thoracotomy. There was significant difference between the two groups of patients with regard to the operative time (104± 9.8 vs. 149 ±15.4 min). Twenty patients (45%) developed postoperative complications, with a morbidity rate of 41 and 50%, respectively, with no significant difference between the two groups. No mortality was recorded.

Conclusion: Repair of congenital TEF associated with RAA can be performed through right thoracotomy safely but with some difficulty and longer time.

Keywords: congenital tracheoesophageal fistula, right-sided aortic arch, right thoracotomy