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

C Gigena*, M Azizoğlu**, M Gazzaneo***, TO Kamçı****, M Escolino*****, S Klyuev******, E Karakaş*******, T Risteksi********, MF Marenco Gutiérrez*********, A Mutanen**********, C Esposito*****

*Cincinnati Children's, Pediatric Surgery, Cincinnati, OH, USA. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
**Istanbul Esenyurt State Hospital, Dep. of Pediatric Surgery, Istinye University, Dep. of Stem Cell and Tissue Engineering, Pediatric Surgery Meta-Analysis Study Group (PESMA)
***Dipartimento Pediatrico, UO Chirurgia Pediatrica, ASST Spedali Civili di Brescia, Università di Brescia, Italia. Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. Pediatric Surgery
****Dicle University, Department of Pediatric Surgery, Diyarbakir, Turkey; Pediatric Surgery Meta-Analysis Study Group (PeSMA), Turkey.
*****University of Naples Federico II, Pediatric Surgery Naples, Italy. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
******AO GK "MEDSI", Department of Pediatric Surgery, Moscow, Russia Federation. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
*******Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
********Ss. Cyril and Methodius University of Skopje, Faculty of Medicine, Department of Pediatric Surgery, Skopje, North Macedonia, Pediatric Surgery Meta-Analysis Study Group (PeSMA) (pesmastudy@gmail.com)
*********Department of Pediatric Surgery, Hospital Fernando Vélez Paiz, Managua, Nicaragua. Pediatric Surgery Meta-Analysis Study Group (PESMA), Turkey.
**********Department of Paediatric Surgery, The New Children's Hospital, University of Helsinki, Helsinki, Finland. Pediatric Surgery Meta Analysis Study Gorup (PESMA)

Aim

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.

Keywords: Esophageal atresia, azygos vein preservation, azygos vein ligation, surgical outcomes

Azygos veninin korunmasının özofagus atrezisi onarımındaki etkileri: bir systematik inceleme ve meta-analiz

C Gigena*, M Azizoğlu**, M Gazzaneo***, TO Kamçı****, M Escolino*****, S Klyuev******, E Karakaş*******, T Risteksi********, MF Marenco Gutiérrez*********, A Mutanen**********, C Esposito*****

*Cincinnati Children's, Pediatric Surgery, Cincinnati, OH, USA. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
**Istanbul Esenyurt State Hospital, Dep. of Pediatric Surgery, Istinye University, Dep. of Stem Cell and Tissue Engineering, Pediatric Surgery Meta-Analysis Study Group (PESMA)
***Dipartimento Pediatrico, UO Chirurgia Pediatrica, ASST Spedali Civili di Brescia, Università di Brescia, Italia. Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. Pediatric Surgery
****Dicle University, Department of Pediatric Surgery, Diyarbakir, Turkey; Pediatric Surgery Meta-Analysis Study Group (PeSMA), Turkey.
*****University of Naples Federico II, Pediatric Surgery Naples, Italy. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
******AO GK
*******Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
********Ss. Cyril and Methodius University of Skopje, Faculty of Medicine, Department of Pediatric Surgery, Skopje, North Macedonia, Pediatric Surgery Meta-Analysis Study Group (PeSMA) (pesmastudy@gmail.com)
*********Department of Pediatric Surgery, Hospital Fernando Vélez Paiz, Managua, Nicaragua. Pediatric Surgery Meta-Analysis Study Group (PESMA), Turkey.
**********Department of Paediatric Surgery, The New Children's Hospital, University of Helsinki, Helsinki, Finland. Pediatric Surgery Meta Analysis Study Gorup (PESMA)

Amaç

Bu çalışmanın amacı, azygos veninin korunmasının (PAV) özofagus atrezisi-trakeoözofageal fistül (EA-TEF) onarımındaki postoperatif komplikasyonlar üzerindeki etkisini değerlendirmektir.

Yöntem

EMBASE, PubMed, Medline, SCOPUS, Web of Science ve Cochrane veritabanları kullanılarak Temmuz 2024'e kadar olan tüm ilgili yayınları kapsayan bir İngilizce literatür taraması yapıldı. Azygos veninin korunmasının anastomoz kaçağı, özofageal darlıklar, akciğer enfeksiyonları ve mortalite gibi postoperatif komplikasyonlar üzerindeki etkisi analiz edildi. Hastalar azygos veninin korunmasının (PAV) ve azygos veninin ligate edilmesi (LAV) olarak iki grub altında analiz edilmiştir.

Bulgular

Toplam 7 çalışma dahil edildi. RCT alt grup analizinde, PAV grubunun daha düşük anastomoz kaçağı oranına sahip olduğu görüldü (I²=0%) (OR: 0.50, 95% CI: 0.28-0.88; p=0.02). Genel analizde, PAV grubunun daha düşük anastomoz darlığı oranına sahip olduğu belirlendi (I²=9%) (OR: 0.58, 95% CI: 0.34-0.97; p=0.04). PAV grubunun, akciğer enfeksiyonu oranı anlamlı olarak daha düşük bulundu (I²=0%) (OR: 0.29, 95% CI: 0.18-0.49; p<0.00001). Ayrıca, PAV grubunun mortalite oranı da anlamlı olarak daha düşüktü (I²=0%) (OR: 0.48, 95% CI: 0.28-0.82; p=0.007). PAV ve LAV gruplarındaki genel mortalite oranları sırasıyla %9.2 ve %18 olarak bulundu.

Sonuç

Azygos veninin korunması, özofagus atrezisi onarımında anastomoz kaçağı, akciğer enfeksiyonu ve mortalite oranlarını azaltmada önemli faydalar sağlamaktadır; bu da cerrahi başarıyı artırabilir. Ancak bu sonuçların randomize kontrollü çalışmalarla desteklenmesi gerekmektedir.

Anahtar Kelimeler: Özofagus atrezisi, azigos ven korunması, azigos ven ligasyonu, cerrahi sonuçları