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