Comparison of ligation versus preservation of azygous vein in primary repair of esophageal atresia with tracheoesophageal fistula in neonates.

Objective: To compare frequency of anastomotic leak with ligation versus preservation of azygos vein in the primary repair of esophageal atresia (EA) with trachea-esophageal fistula (TEF) in neonates. Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Surgery, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2019 to September 2020. Material & Methods: This study involved 180 neonates (1-28 days of life) of both genders undergoing primary repair of EA with TEF and dividied in azygous vein ligation surgery and azygous vein preservation surgery. Outcome variable was frequency of post-operative anastomotic leak. Results: In a total of 180 neonates, mean age was 6.75±6.39 days. Majority (n=130, 72.2%) of the patients were aged ≤7 days. There were 107 (59.4%) male and 73 (40.6%) female neonates. The frequency of anastomotic leak was significantly lower in Azygous vein preservation group (6.7% vs. 20.0%; p=0.009) as compared to azygous vein ligation group. Conclusion: Preservation of azygous vein was associated with significantly lower frequency of post-operative anastomotic leak among neonates undergoing primary repair of EA with TEF.