Letter to the Editor: Preservation of the Azygos Vein in Esophageal Atresia Repair: A Comparative Analysis of Recent Meta-Analyses

jpedsurg.org

Since the first description of primary repair for esophageal atresia (EA), the core surgical technique has remained largely unchanged; however, preservation of the azygos vein (AV) has increasingly been advocated as a preferred approach in recent years. The AV is a major vessel responsible for venous drainage of the esophagus and mediastinum, and a portion of the lymphatic flow also drains into this system. It has been proposed that preservation of the AV may reduce esophageal anastomotic edema and mediastinal inflammation by maintaining adequate venous outflow [1].

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Article · Mar 2026 · 1 min read

In brief

This letter examines the surgical debate around preserving the azygos vein during esophageal atresia repair, comparing recent meta-analyses. Proponents suggest that maintaining this major venous drainage vessel may reduce anastomotic edema and mediastinal inflammation, potentially improving surgical outcomes in neonates.

Azygos vein preservation during EA repair maintains venous drainage of the esophagus and mediastinum, potentially reducing anastomotic edema.
The azygos vein also drains a portion of lymphatic flow, making its preservation theoretically beneficial for postoperative healing.
Despite unchanged core EA repair technique since first description, azygos preservation has gained advocacy as preferred approach in recent years.
Proposed mechanism: preserved azygos vein reduces mediastinal inflammation by maintaining adequate venous outflow from surgical site.

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