title: The management of newborns with esophageal atresia and right aortic arch: A systematic review or still unsolved problem.
abstract: OBJECTIVE
  The management of newborns with esophageal atresia (EA) and right aortic arch (RAA) is still an unsolved problem. This study provides a systematic review of epidemiology, diagnosis, management and short-term results of children with EA and RAA.
  
  
  METHODS
  The PubMed database was searched for original studies on children with EA and RAA. In each study, data were extracted for the following outcomes: number of patients, associated anomalies, type of surgical repair, morbidity and mortality rate.
  
  
  RESULTS
  Eight studies were selected, including 54 patients with EA and RAA. RAA was encountered in 3.6% of infants. Preoperative detection of RAA was reported in 7 of them. In these patients, primary anastomosis was achieved through the right approach in 3 (thoracotomy in 2 and thoracoscopy in 1) while the left approach was the primary choice in 4 (thoracotomy in 2 and thoracoscopy in 2). No significant differences were found between the right and left approaches with regard to leaks (P=0.89), strictures (P=1) or mortality (P=1). In 47/54 patients (87%) RAA was noted during right thoracotomy, and primary anastomosis was achieved through the same approach in 29 (61.7%); conversion to other approaches (left thoracotomy or esophageal substitution) was performed in 15 children (38.3%). No significant differences were found between primary left thoracotomy (LT) and LT after RT with regard to leaks (P=0.89), strictures (P=1) or mortality (P=1).
  
  
  CONCLUSIONS
  Skills and preferences of the surgeon still guide the choice of surgical approach even when preoperatively faced with RAA. A multicenter, prospective randomized study is strongly required.
authors.affiliation: Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy. Electronic address: parfil@hotmail.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Parolini
authors.affiliation: Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Armellini
authors.affiliation: Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Boroni
authors.affiliation: Department of Medical and Surgical Neonatology, Bambino Gesu' Research Children's Hospital, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bagolan
authors.affiliation: Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Alberti
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology; D004933:Esophageal Atresia / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D013906:Thoracoscopy / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects
keywords: Children; Intussusception; Radiation; Reduction; Saline enema; Sonography; Ultrasound