Preservation of Azygos vein in primary repair of esophageal atresia: Nine cases’ experience

INTRODUCTION: Studies on preserving the Azygos vein (AV) in primary esophageal atresia (EA) repair and its effects on complications such as stenosis, anastomotic leakage, and fistula are gradually increasing. We aimed to evaluate cases with preserved AV during primary repair of EA with thoracotomy.
METHODS: The demographic data, operation notes, and postoperative outcomes of primary EA repair cases with preserved AVs operated between 2016 and 2021 were evaluated from hospital records, retrospectively.
RESULTS: In 5 years, the AVs of 9 neonates with esophageal atresia + distal fistula were preserved in 6 males and 3 females. The mean birth weight was 2374 g. Four cases were preterm. Echocardiography revealed an Interatrial Septal Aneurysm in 1, Fallot’s Tetralogy in 1, and a right aortic arch in 1 patient. The mean age at surgery was 4 days (1–8 days); all patients were operated through a right thoracodorsal incision by the same surgeon. Extra-pleural thoracotomies were completed as intrapleural in four patients. The oblique-oblique anastomosis was tension-free in all cases. Enteral feeding began on the 4th day by nasogastric tube. The median duration of intubation was 6.6 days (1–11 days). Chest tubes were removed on the 10th day (8–14th day). No patient had anastomotic leakage, detachment, or fistula recurrence. The median hospitalization duration was 23.2 days (10–32 days). Four patients underwent esophageal dilation.
DISCUSSION AND CONCLUSION: Postoperative anastomotic leakage, fistula, and stenosis increase mortality and morbidity in children undergoing EA repair. During primary repair, the preservation of AV, which significantly contributes to esophageal drainage, should be preferred unless it increases intraoperative risk.