# Aortopexy With Plication of Kommerell Diverticulum Is an Effective Alternative to Diverticulum Resection and Reimplantation of the Aberrant Left Subclavian Artery for Surgical Management of Vascular Rings in Children

## TL;DR

Aortopexy with plication of Kommerell diverticulum is as effective as traditional resection for treating vascular rings in children.

## Contribution

A new surgical technique combining plication and pexy is shown to be effective for vascular ring management.

## Key findings

- Plication and pexy reduced persistent symptoms compared to ligamentum division alone (32% vs 5%).
- Reoperation rates were similar between the two surgical approaches (5% in each group).
- The new technique is a viable alternative to diverticulum resection and reimplantation.

## Abstract

Right aortic arch with an aberrant left subclavian artery arising from a Kommerell diverticulum is the most common form of vascular ring. We report the outcomes of plication and pexy of the diverticulum in addition to division of the left-sided ligamentum to treat this lesion in children.

Forty-four patients were included in the study; 22 patients underwent division of the ligamentum arteriosum alone, while the other half underwent plication and/or pexy of the Kommerell diverticulum in addition to division of the ligamentum. The primary outcome of interest was reintervention for persistent symptoms following the initial operation. The other outcome studied was symptom relief on follow-up.

The baseline characteristics were similar between the two groups. There was no difference in the ratio of the size of the Kommerell diverticulum to the size of the left subclavian artery between the groups (1.6 vs 1.8, P = .22). The incidence of reoperation was similar in both groups (5% in each group, P = 1); 7/22 (32%) had persistent symptoms after ligamentum division alone, while only 1/22 (5%) had persistent symptoms after plication and/or pexy (P = .05).

Plication of the Kommerell diverticulum with pexy along with division of the ligamentum arteriosum is an effective alternative for treatment of right aortic arch with an aberrant left subclavian artery arising from the diverticulum.