A COMPARATIVE STUDY OF AZYGOS VEIN LIGATION AND PRESERVATION IN ESOPHAGEAL ATRESIA SURGERY: TECHNICAL AND CLINICAL IMPLICATIONS

Abstract

Esophageal atresia (EA) and tracheoesophageal fistula (TEF) were regarded as fatal defects, but nowadays, more than 90% of such cases survive because surgeons’ techniques have been invented. Since the first surgery attempt in 1888, it has gone through numerous improvements; hence, the outcome is improved with minimal complications. In the routine case the azygos vein will be ligated and cut high up to permit of more easy access to the atretic ends of the esophagus and the fistula, in order that anastomosis may be facilitated. Azygos vein also plays a significant role in the mediastinal venous drainage which is identified to prevent postoperative complications such as pneumonitis and anastomotic leaks as demonstrated in the previous studies. Esophageal anastomosis can be performed to the median or lateral of the preserved azygos vein, but lateral technique is more commonly used due to the simplicity of the procedure. The purpose of this prospective comparative study was to evaluate the practicability and potential advantages of performing esophageal anastomosis mediately to the preserved azygos vein. Three groups of 200 patients each were randomized, Group A (azygos vein ligated), Group B (azygos vein preserved and anastomosed laterally), and Group C (azygos vein preserved and anastomosed medially). The results confirmed that there were no considerable discrepancies between the groups in respect of the operative time and the nature of the patients. The development of postoperative complications, pneumonitis, anastomotic leak and mortality were not different in all the groups with the highest rate of complications and mortality in Group A. Although there was no reported difference in post-operative outcome compared to medial anastomosis to the preserved azygos vein, it permitted the restoration of normal anatomical relationships, and provided the most direct path to the neo-esophagus. Technically this operation was possible and it did not increase the operating time.