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- Title
Update on aortopexy and posterior tracheopexy for tracheomalacia in patients with esophageal atresia.
- Authors
Sumida, Wataru; Yasui, Akihiro; Shirota, Chiyoe; Makita, Satoshi; Okamoto, Masamune; Ogata, Seiya; Takimoto, Aitaro; Takada, Shunya; Nakagawa, Yoichi; Kato, Daiki; Gohda, Yousuke; Amano, Hizuru; Guo, Yaohui; Hinoki, Akinari; Uchida, Hiroo
- Abstract
Despite improving the survival after repair of esophageal atresia (EA), the morbidity of EA repair remains high. Specifically, tracheomalacia (TM) is one of the most frequent complications of EA repair. Continuous positive airway pressure is generally applied for the treatment of TM. However, surgical intervention is required against an apparent life-threatening event or inability to perform extubation for a long period. According to our review, most cases of TM showed symptom improvement after aortopexy. The ratio of the trachea's lateral and anterior–posterior diameter at the brachiocephalic artery crossing the trachea, which reflects the compression of the trachea by the brachiocephalic artery, is a good indicator of aortopexy. Our finding suggests that most TM cases associated with EA may not be caused by tracheal fragility alone, but may involve blood vessel compression. Posterior tracheopexy (PT) is also an effective treatment for TM. Recently, open or thoracoscopic PT was able to be performed simultaneously with EA repair. In many cases, aortopexy or PT is a safe and effective surgical treatment for TM with EA. Other surgical procedures, such as external stenting, should be considered for patients with diffuse-type TM for whom aortopexy and PT appear relatively ineffective.
- Subjects
BRACHIOCEPHALIC trunk; CONTINUOUS positive airway pressure; ESOPHAGEAL atresia; BLOOD vessels
- Publication
Surgery Today, 2024, Vol 54, Issue 3, p211
- ISSN
0941-1291
- Publication type
Article
- DOI
10.1007/s00595-023-02652-6