Is Ligation of Azygos Vein Necessary in Primary Repair of Tracheoesophageal Fistula with Esophageal Atresia?

Upadhyaya, Vijai D.; Gangopadhyaya, A N; Gopal, S. C.; Upadhyaya, Ashish; Sharma, Seema; Gupta, Devendra K.; Kumar, Vijayendra; Pandey, Anand

doi:10.1055/s-2007-965693

Cited by 32 publications

(44 citation statements)

References 2 publications

(2 reference statements)

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“…A total number of 50 patients were divided into two equal-sized groups. In the group with preservation of the Azygos vein, the rate of postoperative pneumonitis was significantly lower, and they had more stable hemodynamic condition after surgery [11]. In our study, none of the complications occurred in either group.…”

Section: Discussionmentioning

confidence: 38%

“…In another study, reduction in the rate of postoperative pneumonitis was observed with preservation of the Azygos vein after surgery for TEF [11]. Additionally, pathology in the veins draining cerebrospinal fluid such as the Azygos vein can lead to chronic cerebrospinal venous insufficiency.…”

Section: Introductionmentioning

confidence: 96%

“…Since the Azygos vein is one of the main parts of the venous system in the human body [10,11], preserving it is a goal for surgeons. Here, we aim to study the outcome of the primary repair of TEF with and without Azygos vein ligation and compare early complications, duration of surgery, and hospital and NICU stay between them.…”

Section: Introductionmentioning

confidence: 99%

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

2013

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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.

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Section: Discussionmentioning

confidence: 38%

Section: Introductionmentioning

confidence: 96%

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

2013

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“…The preservation of the azygos vein avoids early postoperative local edema, offering a protective factor against anastomotic leaks. Another study showed a decreased rate of pneumonitis in the postoperative period when preserving the azygos vein (11). Patkowski et al reported a series of 23 patients with EA and TEF corrected by thoracoscopy with preservation of azygos vein (12).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, preservation of azygos vein has been hypothesized to maintain the mediastinal venous drainage, thereby decreasing postoperative chest congestion and tissue edema, thus working as an additional protective factor against postoperative complications like anastomotic leak (10, 11), but this hypothesis was never hemodynamically confirmed. More recently, Patkowski et al performed thoracoscopic repair sparing the azygos vein as a strategy to reduce the fistula recurrence by interposing some natural biological tissue between the anastomosis and fistula stump (12).…”

Section: Introductionmentioning

confidence: 99%

Anatomic Thoracoscopic Repair of Esophageal Atresia

et al. 2017

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BackgroundThe thoracoscopic approach to repair esophageal atresia (EA) with tracheoesophageal fistula (TEF) provides excellent view, allowing the most skillful surgeons to spare the azygos vein by performing the esophageal anastomosis over (on the right side) the azygos vein. Seeking the most anatomic repair, we started to perform the esophageal anastomosis underneath (on the left side) the azygos vein: anatomic thoracoscopic repair of esophageal atresia (ATREA). We aim to compare results of ATREA with the classic thoracoscopic repair.MethodsDuring the last 4 years, in our center, all infants with EA with distal TEF were operated by thoracoscopy sparing the azygos vein. According to the surgical technique, two groups were created: Group A—treated with ATREA and Group B—treated with classic thoracoscopic repair over (on the right side) the azygos vein. We retrospectively collected data regarding features of the newborn (gestational age, gender, karyotype changes, associated anomalies, birth weight), surgery (operative technique, operative time, and surgical complications), hospitalization (duration of mechanical ventilation, thoracic drainage, time for the first feeding, time of admission, and early complications) and follow-up [tracheomalacia, gastroesophageal reflux disease (GERD), anastomotic stricture, recurrence of fistula].ResultsGroup A had seven newborns and Group B had four newborns. There were no statistically significant differences between both groups concerning the evaluated variables on surgery, hospitalization, and follow-up. Nevertheless, in Group A, there was an infant with a right aortic arch where ATREA was particularly useful as it avoided that the azygos vein and the aortic arch were left compressed in between the esophagus and trachea. Postoperatively, one patient of Group B had a major anastomotic leak with empyema requiring surgical re-intervention. During follow-up, anastomotic stricture requiring esophageal dilation occurred with similar rates in both groups. In Group B, one patient had severe and symptomatic tracheomalacia requiring aortopexy and severe GERD requiring fundoplication. No patients developed recurrent fistula.ConclusionThe ATREA is feasible in the great majority of patients with EA with TEF without compromising long-term results and might be particularly useful for those infants with malformations of the cardiac venous return vessels and/or major aortic malformations.

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Preservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia

Korang

Hildorf

Oehlenschlæger

et al. 2021

Cochrane Database of Systematic Reviews

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Is Ligation of Azygos Vein Necessary in Primary Repair of Tracheoesophageal Fistula with Esophageal Atresia?

Cited by 32 publications

References 2 publications

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

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

Anatomic Thoracoscopic Repair of Esophageal Atresia

Preservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia

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