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Background: Tracheoesophageal fistula (TEF) repair in Paediatric Surgery is a critical intervention, often requiring careful consideration of anatomical structures. The azygous vein, situated near the oesophagus and trachea, is a structure of interest in this context. This abstract explores the importance of preserving or not preserving the azygous vein during TEF repair and its potential impact on surgical outcomes. Methodology: A comprehensive review of paediatric surgical cases involving TEF repair was conducted, focusing on the role of the azygous vein. Data from a diverse sample size of paediatric patients, ranging from infants to adolescents, were analysed. Surgical techniques, patient demographics, and postoperative outcomes were assessed to determine the effects of azygous vein preservation or nonpreservation on TEF repair success. Results: Our analysis revealed that azygous vein preservation during TEF repair was associated with a significantly higher rate of surgical success (40%) compared to cases where the azygous vein was not preserved (32%). Furthermore, the preservation group had a lower rate of surgical failure (10%) in contrast to the non-preservation group (18%). These findings are in line with previous studies and were highly statistically significant, as indicated by the odds ratio (OR) of 2.00 with a 95% confidence interval (CI) of 1.32 to 3.02 and a P-value of < 0.001. While the decision to preserve the azygous vein led to slightly longer operative times and potential risk decreases the venous congestion not causing congestion. These factors did not outweigh the advantages of preservation, as evidenced by the superior surgical outcomes. The sample size comprised fifty (50) paediatric patients, with 50% undergoing azygous vein preservation and 50% without preservation. Conclusion: The decision to preserve or not preserve the azygous vein during TEF repair in paediatric surgery should be made on a case-by-case basis, considering the patient's unique anatomy and the surgeon's expertise. Our findings suggest that both approaches can yield successful outcomes, but careful patient selection and surgical planning are essential to optimize results. Future research should focus on developing clear guidelines to aid surgeons in making this critical decision. [ABSTRACT FROM AUTHOR]