Howard Alexandria K, Nordness Paul
General Surgery, Edward Via College of Osteopathic Medicine, Auburn, USA.
General Surgery, Gadsden Regional Medical Center, Gadsden, USA.
Cureus. 2025 Apr 9;17(4):e81966. doi: 10.7759/cureus.81966. eCollection 2025 Apr.
A right aortic arch (RAA) is a rare vascular anomaly that is often asymptomatic but may present challenges during foregut surgery depending on its branching pattern and course. We present the case of a 54-year-old female with a known RAA and gastroesophageal reflux disease (GERD) refractory to maximal medical therapy. She underwent robot-assisted laparoscopic paraesophageal hiatal hernia repair. Preoperative CT imaging confirmed a right-sided descending aorta crossing midline at T11 without evidence of extrinsic esophageal compression. Surgical precautions included careful preoperative planning and intraoperative dissection to avoid vascular injury due to the aberrant anatomy. The patient recovered uneventfully and reported resolution of reflux symptoms at follow-up, confirmed by symptom assessment and improvement in diet tolerance. This case underscores the need to consider vascular anomalies when planning surgical intervention for GERD, especially in refractory cases. It highlights the role of robotic-assisted surgery in safely managing complex anatomy.
右位主动脉弓（RAA）是一种罕见的血管异常，通常无症状，但根据其分支模式和走行，在前肠手术中可能会带来挑战。我们报告一例54岁女性患者，已知患有RAA和经最大程度药物治疗仍难治的胃食管反流病（GERD）。她接受了机器人辅助腹腔镜食管旁裂孔疝修补术。术前CT成像证实右侧降主动脉在T11水平穿过中线，无食管外压迹象。手术注意事项包括术前仔细规划和术中解剖，以避免因异常解剖结构导致血管损伤。患者恢复顺利，随访时报告反流症状缓解，经症状评估和饮食耐受性改善得以证实。该病例强调在为GERD规划手术干预时，尤其是难治性病例，需要考虑血管异常。它突出了机器人辅助手术在安全处理复杂解剖结构中的作用。
