European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
January 20, 2026 · via Europe PMC
Impact of Azygos Vein Preservation on Postoperative Outcomes in Esophageal Atresia: A Systematic Review and Meta-Analysis from the Pediatric Surgery Meta-Analysis (PESMA) Study Group.
Heitsman CG, Azizoğlu M, Gazzaneo M, +10 more, Esposito C.
AI summary — for doctors, generated from the abstract only
A systematic review and meta-analysis of 7 studies suggests that preserving the azygos vein during esophageal atresia with tracheoesophageal fistula repair may reduce anastomotic leak, chest infection, and mortality compared with ligation, but the evidence is limited by small, heterogeneous studies.
What was studied
A systematic review and meta-analysis (searching six major databases through January 2025) of 7 studies (5 randomized controlled trials, 2 retrospective analyses) comparing azygos vein preservation versus ligation during repair of esophageal atresia with tracheoesophageal fistula (EA-TEF), assessing anastomotic leaks, esophageal strictures, chest infections, and mortality.
Key findings
- Across studies, azygos vein preservation was generally associated with fewer postoperative complications compared with ligation.
- Preservation appeared to reduce the risk of anastomotic leak, chest infection, and mortality, with a trend toward fewer strictures, though specific pooled effect sizes are not given in the abstract.
- The authors explicitly note the strength of evidence was limited by study heterogeneity and small sample sizes.
- The review concludes that larger, high-quality randomized trials are needed to confirm whether azygos vein preservation directly improves outcomes.
Clinical relevance
The findings suggest surgeons performing EA-TEF repair might consider preserving the azygos vein given the signal toward fewer complications, but the authors explicitly caution these results should be interpreted with caution given the limited quality of underlying evidence.
Who should care
Limitations
The authors state the included studies were mostly small and of mixed quality, with heterogeneity in surgical technique, directly limiting confidence in the conclusions; larger high-quality trials are called for.
Preserving rather than tying off the azygos vein during esophageal atresia repair may lower complication risk, but the current evidence is not yet strong enough to be definitive.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objective
This study aimed to evaluate whether preservation of the azygos vein influences postoperative outcomes in infants undergoing repair of esophageal atresia with tracheoesophageal fistula (EA-TEF).
Methods
A systematic review and meta-analysis were conducted using six major databases, identifying all relevant studies published up to January 2025. Seven studies met the inclusion criteria, including five randomized controlled trials and two retrospective analyses. Outcomes assessed were anastomotic leaks, esophageal strictures, chest infections, and mortality.
Results
Across studies, azygos vein preservation was generally associated with fewer postoperative complications compared with ligation. Preservation of the azygos vein appeared to reduce the risk of anastomotic leak, chest infection, and mortality, while also showing a trend toward fewer strictures. However, the strength of evidence was limited by study heterogeneity, small sample sizes, and variation in surgical techniques.
Conclusion
This systematic review and meta-analysis suggest that preserving the azygos vein may be beneficial in reducing major postoperative complications. Nevertheless, because most included studies were small and of mixed quality, these findings should be interpreted with caution. Larger, high-quality randomized trials are needed to confirm whether azygos vein preservation directly improves clinical outcomes.
DOI
10.1055/a-2787-2370
PMID
41558660
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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