Evaluating Necessity of Azygos Vein Ligation in Primary Repair of Esophageal Atresia

Abstract

Surgery has dramatically improved survival of infants with esophageal atresia. However, early and late complications of these surgeries affect the future life of this population. A probable step toward minimizing such complications is through modifying the technique of surgery. We evaluated two groups of esophageal atresia undergoing surgery with two different techniques including preservation and ligation of the Azygos vein and compared early complications, duration of surgery, and hospital and neonatal intensive care unit (NICU) stay between them. A total number of 24 patients with mean age of 24 to 48 h, who were diagnosed with esophageal atresia, were included in the study. All cases were randomly allocated in two groups: group A (case group) in which patients underwent surgery with preservation of the Azygos vein and group B (control group) in which patients underwent the former surgical method with ligation of the Azygos vein. Incidence of early complications, duration of surgery, and NICU and hospital stay were compared between the two groups. None of the complications occurred in either group. Duration of surgery, NICU stay, and hospital stay were not statistically significant between the groups. Preserving the Azygos vein during esophageal atresia surgery is probably a good modification of the classic technique.

A unique variation of azygos system of veins

“…[13] The knowledge of variation of the azygos system is also important during the surgery to repair the esophageal atresia. [14] It is possible to identify the gross anomalies like azygos continuation of inferior vena cava[15] and absence of superior vena cava. [16] However the less frequent, uncommon variations might lead to confusions during echocardiography or any other procedures.…”

Azygos vein preservation is feasible and beneficial in esophageal atresia with tracheoesophageal fistula: A meta-analysis of randomized controlled trials

“…Forty-eight potentially eligible records were identified by using the search strategy. After carefully reviewing the titles and abstracts of these publications, the full texts and reference lists of 7 records were scrutinized, and 4 articles meeting the inclusion criteria were ultimately included in the final analyses ( 5 , 8 , 10 , 11 ). Table 1 summarizes the baseline characteristics and Jadad scores of these four studies.…”

“…Although all four records reported the average operative time ( 5 , 8 , 10 , 11 ), only one record reported the average operative time with standard deviation ( 10 ). The results of three studies found a longer mean operative time in the preservation group than in the ligation group, ( 8 , 10 , 11 ) ranging from 0 to 10 min, while one study showed a longer mean operative time in the ligation group than in the preservation group ( 5 ).…”

“…All four studies reported the incidence of anastomotic leakage as an outcome in pediatric patients with EA/TEF ( 5 , 8 , 10 , 11 ). The incidence of anastomotic leakage was 10.37% (17, n = 164) in the preservation group and 18.03% (22, n = 122) in the ligation group.…”

“…Some researchers believe that ligation of the azygos vein will aggravate postoperative edema at the anastomosis and chest congestion and consequently lead to higher incidences of complications, including anastomotic leakage and pneumonitis (5,8). Although a series of studies have been performed to verify this assumption, those studies have failed to achieve consistent conclusions (5,(8)(9)(10)(11). Concerns are raised regarding whether azygos vein preservation will increase the difficulty or time of operation and reduce the quality of anastomosis.…”