A COMPARATIVE STUDY BETWEEN SURGICAL OUTCOMES IN OESOPHAGEAL ATRESIA WITH DISTAL TRACHEO-OESOPHAGEAL FISTULA REPAIR WITH LIGATED AND PRESERVED AZYGOS VEIN

BACKGROUND Oesophageal atresia and tracheo-oesophageal fistula are some of the most challenging surgical problems in neonates. Improvement in surgical techniques and peri-operative management made the survival better. It will be worthwhile to study the anomaly and improve different techniques of surgical approach for manoeuvrability and outcome. The objective of this study is to evaluate the results of preservation of Azygos vein during the operation for TEF repair. MATERIALS AND METHODS This comparative study was carried out in the Department of Paediatric Surgery of SVP Postgraduate Institute of Paediatrics, SCB Medical College, Cuttack, Odisha over a period of two years from Sept 2013 - 2015. Since the study duration was short, we had to limit the sample size for convenience. 60 full-term neonates with TEF having birth weight > 2 Kgs., ages of presentation < 2 days and without mechanical ventilation were selected for the study. Total of 60 cases on the study were divided into three groups and each group having 20 (Group A, B, C). Group A (n= 20) where azygos vein was ligated and divided, Group B (n= 20) where azygos vein was preserved, and anastomosis was done lateral to vein and Group C (n= 20) where azygos vein was preserved, and anastomosis was done medial to vein. The outcome of study was compared using student's "t" test and Chi-square test. RESULTS 60 cases of TEF with EA were divided into 3 groups randomly before operation. Group A (20) ligating the Azygos vein, Group B without ligating the vein and performing lateral anastomosis and Group C with preserved Azygos vein and medial anastomosis. Results were compared with operation time, development of pneumonitis, anastomotic leaks and mortality. All the three groups did not have statistically significant difference in the above parameters. CONCLUSION Though statistically not different, the operation time is marginally shorter in Group A and complications are marginally better in Group B and C. Medial anastomosis preserving the Azygos vein should be preferred, as it does not obstruct the natural venous drainage.