Evaluation of surgical outcomes of thoracoscopic esophageal atresia repair with and without preservation of azygos vein: a retrospective cohort study.

backgroundEsophageal atresia is an incomplete formation of esophagus, resulting in discontinuity between proximal and distal segments. During the surgical repair, whether the azygos vein should be ligated or preserved is still up for debate. The study aims to compare the postoperative outcomes of esophageal atresia repair with and without preservation of azygos vein. METHODOLOGY: A retrospective cohort study was conducted at the Institute of Mother and Child Centre, Nawabshah, Pakistan, from 2010 to 2023. The study included neonates undergoing repair for esophageal atresia. Demographic, intraoperative, and postoperative data were reported. Comparative analysis was proceeded through an independent T-test/Mann-Whitney U test. Multivariate analysis was employed. Statistical analysis was undertaken using SPSS with significance dictated at p < 0.05.

resultAmong 200 neonates, patients were segregated into Group A: preservation of azygos vein (n = 67) and Group B: ligation of azygos vein (n = 133). Group A demonstrated lower complication rates than group B. There were 5 (7.5%) vs. 25 (12.5%) cases of anastomotic leaks. (p = 0.034) and 4 (2%) vs. 22 (11%) cases of anastomotic strictures, (p = 0.036) in azygos vein preservation and ligation groups, respectively. However, azygos vein bleeding and mortality did not reach statistical significance. After adjustment for birth weight, gestational age, and congenital anomalies, azygos vein preservation was not independently associated with anastomotic leak. However, preservation was independently associated with reduced anastomotic strictures and lower mortality.

conclusionPreservation of the azygos vein during esophageal atresia repair associated with reduced rate of anastomotic stricture and mortality. Prospective studies with large sample sizes are recommended to validate these findings.