The impact of Kommerell diverticulum resection on patient outcomes: A 21-year comparative analysis of surgical techniques for vascular rings.

OBJECTIVE

Kommerell diverticulum is an embryologic remnant of the dorsal fourth aortic arch. It often presents as part of vascular rings with a right dominant arch. Historically, these have been treated by dividing the ligamentum arteriosum. In recent years, some centers have adopted Kommerell diverticulum resection with subclavian translocation as a primary approach. However, no long-term studies have directly compared outcomes with simple ligamentum division. To address this, we conducted a 21-year dual-institution review comparing short- and long-term outcomes across surgical strategies.

METHODS

A retrospective review of 131 patients who underwent vascular ring repair at 2 institutions was performed. Of these, 93 underwent simple ligamentum division and 38 underwent Kommerell diverticulum resection with subclavian artery translocation. Anatomic subtypes, symptoms, perioperative outcomes, and follow-up data were compared.

RESULTS

There were no significant differences in intraoperative or postoperative complication rates between groups. Short-term symptoms such as dyspnea (P = .56), cough (P = .72), and dysphagia (P = .55) were comparable. Rates of recurrent laryngeal nerve injury (P = .67), chylothorax (P = .18), infection (P = .62), hospital stay (P = .49), and 30-day readmission (P = .63) were also similar. Four patients in the simple division group required reoperation; none did in the Kommerell diverticulum group (P = .32). Symptom recurrence at long-term follow-up did not differ significantly (P = .30).

CONCLUSIONS

Kommerell diverticulum resection with arterial translocation is safe and effective, with favorable outcomes comparable to simple ligamentum division.