Is ligation of azygos vein necessary in primary repair of tracheoesophageal fistula with esophageal atresia?

Introduction: Congenital tracheoesophageal fistula with esophageal atresia (TEF with EA) is not an uncommon disease of newborns. Classical approach for primary repair of TEF with EA is right thoracotomy with extrapleural approach, ligation of the azygos vein, identification and ligation of tracheoesophageal fistula, identification of upper esophageal pouch and end-to-end anastomosis. This study was conducted to evaluate if the ligation of the azygos vein is a must during primary repair of TEF with EA.

Method: We studied 50 randomly selected cases in the last two years (Jan 2003 - Jan 2005). In 25 babies (group A), primary repair was done with preservation of the azygous vein while 25 babies (group B) were operated with a classical approach with ligation and division of the azygos vein. The postoperative result was comparative in both cases.

Result: Postoperative pneumonitis was higher in the babies operated with the classical approach (56 % in group B and 12 % in group A) and was found to be statistically significant. In postoperative complication, anastomotic leak was slightly higher in group B but was not statistically significant. Mortality rate was similar in both groups. Babies in group A were hemodynamically more stable in comparison to group B.

Conclusion: Preservation of the azygos vein maintains the normal venous drainage of mediastinum and hence decreases the postoperative chest congestion and pneumonitis in the postoperative period in cases of congenital esophageal atresia with tracheoesophageal fistula, so it should be preserved whenever possible.