Open Surgical Repair of Congenital Esophageal Atresia and Tracheoesophageal Fistula by Azygos Spring Versus Classic Repair

Abstract

Background: The open EA/TEF repair is a test of surgical skills of a pediatric surgeon. In a baby with EA and a distal TEF, the lungs may be exposed to gastric secretions, air from the trachea can pass down the distal fistula when the baby cries, strains, or receives ventilation. This condition can lead to an acute gastric perforation, which is often lethal. The thoracoscopic approach to repair EA/TEF provides excellent view, allowing the most skillful surgeons to spare the azygos vein by performing the esophageal anastomosis over (on the right side) the azygos vein. Aim of the study was to compare a short-term outcome of open surgical repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) by Azygos spring versus classic repair. Patients and Mehods: This prospective comparative study was carried out at the Pediatric Surgery Department, at Zagazig University Hospital during the period study year 2017 till the year 2019, 22 neonates diagnosed with EA/TEF were admitted to NICU undergoing azygos spring repair versus 22 NICU neonates diagnosed with EA/TEF undergoing classic repair operations. Results: Regarding short-outcome results, leakage, pneumonia, and overall complications were significantly in lower rate with Azygos repair and associated with classic group. Conclusion: Open surgical repair of EA/TEF with preservation of the azygous vein and if possible immediate or early extubation, leads to good results if performed by an experienced surgeon with respect to other perioperative factors.