Journal of pediatric surgery · 2026
Preservation of the azygos vein versus ligation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula - A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Shahid Usama, Jameel Khadija, Sajid Areeba, Baig Eesha, Hasnain Ummulkiram, Sajid Barka, Saqib Vania, Rehman Usmani Shajie Ur
Аннотация
INTRODUCTION: Esophageal atresia-tracheoesophageal fistula (EA-TEF) is amongst the most common life-threatening developmental anomalies. For the surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF), several interventional modifications have been suggested. One such modification is the preservation of the azygos vein, a key draining vein for the esophagus and surrounding structures. However, there is no clear consensus on the subject.
OBJECTIVE: To evaluate whether preservation of the azygous vein offers clinical benefits compared with its ligation during primary repair of esophageal atresia.
METHODOLOGY: A comprehensive review of the literature was conducted across PubMed, Cochrane Library (CENTRAL), ScienceDirect, and Google Scholar for eligible studies from inception till July 2025. Eligible studies included were Randomized Controlled Trials (RCTs) and non-Randomized Control Trials (non-RCTs) comparing surgical correction of EA-TEF in neonates with Azygous vein ligation vs preservation. Quality assessment was done using Cochrane RoB-2 and ROBINS-I, while Eggers Begg test was used for Publication bias. Data was pooled using a Random-effects model, and heterogeneity was assessed via I2 statistics.
RESULTS: Nine studies, six RCTs, two retrospective studies, and one prospective study, including a total of 955 newborns, met the inclusion criteria. The analysis indicated that preservation of the azygos vein was associated with decreased incidence infections (RR = 0.34; 95 % CI: 0.22 to 0.52; P < 0.001), and mortality (RR = 0.46; 95 % CI = 0.27 to 0.77; P = 0.003). However, no significant difference in operative time, anastomotic leakage, incidence of tracheoesophageal fistula and esophageal stricture were identified between the two groups.
CONCLUSION: Preservation of the azygos vein during esophageal atresia repair appears to reduce mortality and postoperative infections. However, further high-quality multicenter studies are needed to confirm these benefits.
OBJECTIVE: To evaluate whether preservation of the azygous vein offers clinical benefits compared with its ligation during primary repair of esophageal atresia.
METHODOLOGY: A comprehensive review of the literature was conducted across PubMed, Cochrane Library (CENTRAL), ScienceDirect, and Google Scholar for eligible studies from inception till July 2025. Eligible studies included were Randomized Controlled Trials (RCTs) and non-Randomized Control Trials (non-RCTs) comparing surgical correction of EA-TEF in neonates with Azygous vein ligation vs preservation. Quality assessment was done using Cochrane RoB-2 and ROBINS-I, while Eggers Begg test was used for Publication bias. Data was pooled using a Random-effects model, and heterogeneity was assessed via I2 statistics.
RESULTS: Nine studies, six RCTs, two retrospective studies, and one prospective study, including a total of 955 newborns, met the inclusion criteria. The analysis indicated that preservation of the azygos vein was associated with decreased incidence infections (RR = 0.34; 95 % CI: 0.22 to 0.52; P < 0.001), and mortality (RR = 0.46; 95 % CI = 0.27 to 0.77; P = 0.003). However, no significant difference in operative time, anastomotic leakage, incidence of tracheoesophageal fistula and esophageal stricture were identified between the two groups.
CONCLUSION: Preservation of the azygos vein during esophageal atresia repair appears to reduce mortality and postoperative infections. However, further high-quality multicenter studies are needed to confirm these benefits.