Surgical Outcomes of Tracheoesophageal Fistula Repair with and without Azygos Vein Preservation. A comparative Study

Abstract Background Since the Azygos vein is a functional important part of the venous system in the human body, it is rational to recommend preserving this vein during surgery for esophageal atresia. Benefits from preserving this vein, make this modification more favorable in future surgical principles. The aim of this study to report the benefits of Azygos vein preservation during the surgery for esophageal atresia with tracheoesophageal fistula (EA&TEF), highlighting the advantages in terms of, prevention of anastomotic leak, survival rate and other post-operative outcomes. Patients and methods The study included all neonates with esophageal atresia with tracheoesophageal fistula (EA&TEF), admitted at the Department of Pediatric Surgery, Al-Azhar University between April 2020 to January 2023, 32 cases were reviewed prospectively for azygos vein preservation during TEF repair; and were compared with the randomly selected 32 cases of Azygos vein disconnection. Results The two groups were comparable in respect to sex, weight, prematurity, associated anomalies, Spitz classification, operative time and distance between the pouches after mobilization. Anastomotic leak occurred in 2 case (6.2%) in Group A and 6 cases (18.7%) in Group B, pneumonitis occurred in 4 cases of group A and 16 cases in group B. There were two mortalities in Group A. and there were 8 cases of mortality in Group B due to sever pneumonitis and sepsis. Conclusion Preservation of Azygos vein resulted in significant reduction in the number of mortality, pneumonitis and leak. We propose that preservation of the Azygos vein is very important and valuable modification of the current surgical procedure.