Impact of preservation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF): a systematic review and meta-analysis

Kainth, Deepika; Anand, Sachit; Singh, Apoorv; Bajpai, Minu

doi:10.1007/s00383-021-04913-2

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…e findings of the present study are also supported by the literature [3]. Given the pathological characteristics and pathogenesis of H-TEF and the limitations of various diagnostic techniques, this study employed the triple-lumen double-balloon catheter technique, blocking the upper and lower ends of the oesophagus with balloons and creating a positive pressure in the oesophagus with contrast media [22][23][24] to detect whether a fistula existed. e triple-lumen double-balloon catheter technique proved a significant application value for the diagnosis of H-TEF.…”

Section: Discussionsupporting

confidence: 79%

Analysis of the Application Value of Different Esophagography Techniques in the Diagnosis of H-Type Tracheoesophageal Fistula in Neonates

Deng

Luo

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. The study aimed to analyse the detection rates of the triple-lumen double-balloon catheter technique and conventional esophagography in diagnosing H-type tracheoesophageal fistula (H-TEF) in neonates. Methods. The data of 8 neonates diagnosed with H-TEF by surgery in the researchers’ hospital between January 2015 and January 2022 were collected. We compared the detection (true positive) rates of H-TEF by the triple-lumen double-balloon catheter technique, conventional esophagography, and multidetector row spiral CT. Results. Before surgery, conventional esophagography was applied in all 8 cases, of which the H-TEF diagnosis was confirmed in 5 cases and TEF was suspected in 3 cases. The triple-lumen double-balloon catheter technique was employed in 5 cases, of which 4 were confirmed with H-TEF and 1 was suspected with TEF. Multidetector row spiral CT was performed in 4 cases, and 1 case was confirmed with H-TEF, while no fistula was observed in the other 3 cases. The triple-lumen double-balloon catheter technique yielded a 100% detection rate, while conventional esophagography revealed a 62.5% rate and multidetector row spiral CT showed a 25% rate. By comparative analysis, the true positive rates (TPRs) of the triple-lumen double-balloon catheter technique and conventional esophagography were not significantly different ( P = 0.118 ). No significant differences were recorded in TPRs between conventional esophagography and multidetector row spiral CT ( P = 0.221 ). However, the triple-lumen double-balloon catheter technique had a significantly higher TPR than multidetector row spiral CT ( P = 0.118 ). Conclusion. To diagnose congenital H-TEF in neonates, conventional esophagography is a highly valuable yet inconsistently reliable method and the diagnostic value of CT is relatively limited. The triple-lumen double-balloon catheter technique boasts a significantly valuable application for H-TEF diagnosis. Being simple, economical, and effective, it barely requires state-of-the-art facilities, and no complications have occurred during its clinical practice. These advantages justify a possible wider application of the triple-lumen double-balloon catheter technique in clinical practice.

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Section: Discussionsupporting

confidence: 79%

Analysis of the Application Value of Different Esophagography Techniques in the Diagnosis of H-Type Tracheoesophageal Fistula in Neonates

Deng

Luo

2022

Evidence-Based Complementary and Alternative Medicine

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“…They also concluded that preservation of azygos vein had lower incidence of esophageal stricture after one year of follow up (p=<0.05). 8 In 12 Upadhyaya VD et al found that preservation of azygos vein maintained normal venous drainage of mediastinum so resulted in reduction in post-operative chest congestion and pneumonia. 13 Some other researchers have also shown that although, preservation of zygos vein restored normal mediastinal anatomy but resulted in relatively increased surgery time and did not impart beneficial outcomes in terms of mortality or post-surgical complications.…”

Section: Resultsmentioning

confidence: 99%

Comparison of ligation versus preservation of azygous vein in primary repair of esophageal atresia with tracheoesophageal fistula in neonates.

Shah

Anwar

Khan

et al. 2023

TPMJ

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Objective: To compare frequency of anastomotic leak with ligation versus preservation of azygos vein in the primary repair of esophageal atresia (EA) with trachea-esophageal fistula (TEF) in neonates. Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Surgery, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2019 to September 2020. Material & Methods: This study involved 180 neonates (1-28 days of life) of both genders undergoing primary repair of EA with TEF and dividied in azygous vein ligation surgery and azygous vein preservation surgery. Outcome variable was frequency of post-operative anastomotic leak. Results: In a total of 180 neonates, mean age was 6.75±6.39 days. Majority (n=130, 72.2%) of the patients were aged ≤7 days. There were 107 (59.4%) male and 73 (40.6%) female neonates. The frequency of anastomotic leak was significantly lower in Azygous vein preservation group (6.7% vs. 20.0%; p=0.009) as compared to azygous vein ligation group. Conclusion: Preservation of azygous vein was associated with significantly lower frequency of post-operative anastomotic leak among neonates undergoing primary repair of EA with TEF.

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“…In their meta-analysis on the influence of Azygos vein preservation, Kainth et al recommended conducting a randomized controlled trial with a large sample size using a standardized operating technique for the surgical repair of esophageal atresia/tracheoesophageal fistula. Consequently, the two operating approaches employed in our study, which were standardized by the same surgical team, were used to compare the surgical outcomes of the two groups of TEF patients and to evaluate the effects of preserving the Azygos vein on surgical outcomes [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Azygos vein preservation revisited: impact on early outcomes after repair of esophageal atresia/tracheoesophageal fistula in newborns

Daboos,

Abdelmaboud,

Hussein

et al. 2023

Updates Surg

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Since the first successful repair of esophageal atresia/tracheoesophageal fistula (EA–TEF) was performed approximately 8 decades ago, surgeons have made considerable technical advances in solving intraoperative surgical challenges and reducing postoperative complications. According to some surgeons, preserving the Azygos vein makes this modification attractive. This study aimed to evaluate the benefits of preserving the Azygos vein during surgery for esophageal atresia with tracheoesophageal fistula and to highlight its advantages in reducing anastomotic leak, stricture, and other postoperative outcomes. This prospective comparative series was conducted between April 2020 and April 2023. The study included all newborns with EA–TEF eligible for primary repair. Patients were randomized to either Group A or B. Group A underwent Azygos vein preservation, whereas the remaining patients (Group B) underwent Azygos vein disconnection. Sixty-four patients were included in this study. Thirty-two patients (Group A) underwent Azygos vein preservation during EA–TEF repair, and the remaining thirty-two patients (Group B) underwent Azygos vein ligation and disconnection. Both groups were comparable in terms of demographics, clinical data, and operative findings (P > 0.05). Pneumonitis occurred in 4 patients in Group A and 16 patients in Group B. Anastomotic leaks occurred in two (6.2%) patients in Group A and six (18.7%) patients in Group B. There were two deaths in Group A and six deaths in Group B, with a significant difference between the two groups (P = 0.0485). Preserving the Azygos vein during esophageal atresia repair reduces the occurrence of postoperative pneumonia, leakage, and stenosis, and decreases postoperative mortality. Therefore, we declare that this modification is a significant and valuable addition to the current surgical procedures.

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Impact of preservation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF): a systematic review and meta-analysis

Cited by 6 publications

References 17 publications

Analysis of the Application Value of Different Esophagography Techniques in the Diagnosis of H-Type Tracheoesophageal Fistula in Neonates

Analysis of the Application Value of Different Esophagography Techniques in the Diagnosis of H-Type Tracheoesophageal Fistula in Neonates

Comparison of ligation versus preservation of azygous vein in primary repair of esophageal atresia with tracheoesophageal fistula in neonates.

Azygos vein preservation revisited: impact on early outcomes after repair of esophageal atresia/tracheoesophageal fistula in newborns

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