Effects of azygos vein preservation in esophageal atresia repair: a systematic review and meta analysis

Abstract

The purpose of this study is to evaluate the impact of azygos vein preservation on postoperative complications in esophageal atresia-tracheoesophageal fistula (EA-TEF). Method We performed English literature review using EMBASE, PubMed, Medline, SCOPUS, Web of Science, and Cochrane databases, encompassing all relevant publications up to July 2024. The impact of azygos vein preservation on postoperative complications, including anastomotic leaks, esophageal strictures, chest infections, and mortality were analysed. Patients were analyzed in two groups as azygos vein preservation (PAV) and azygos vein ligation (LAV). Results A total of 7 studies were included. RCT subgroup analysis showed that PAV group has lower anastomotic leak rate (I²=0%) (OR: 0.50, 95% CI: 0.28 to 0.88; p=0.02). Overall analysis showed that the PAV group has a lower anastomotic stricture rate (I²=9%) (OR: 0.58, 95% CI: 0.34 to 0.97; p=0.04). The PAV group had a significantly lower chest infection rate (I²=0%) (OR: 0.29, 95% CI: 0.18 to 0.49; p<0.00001). The PAV group had a significantly lower mortality rate (I²=0%) (OR: 0.48, 95% CI: 0.28 to 0.82; p=0.007). The overall mortality rates in the PAV and LAV groups were 9.2% and 18%, respectively. Conclusion The preservation of the azygos vein provides significant benefits in reducing anastomotic leaks, pulmonary infections, and mortality rates in esophageal atresia repair, potentially enhancing surgical success. However, these results need to be supported by randomized controlled trials.