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Management of persistent tracheocutaneous fistula in the pediatric age group

Y Stern1, M Cosenza, D L Walner

  • 1Department of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, Ohio, USA.

The Annals of Otology, Rhinology, and Laryngology
|October 20, 1999
PubMed

Insights

Surgical repair of persistent tracheocutaneous fistula (TCF) in children, using primary closure or secondary intention, is safe and effective. Postoperative outcomes showed no significant difference based on repair method or intubation duration.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Surgical Innovation

Background:

  • Persistent tracheocutaneous fistula (TCF) in children necessitates surgical intervention.
  • Various surgical techniques and postoperative care strategies exist for TCF management.
  • Optimal management strategies require comparative analysis.

Purpose of the Study:

  • To compare different surgical methods for TCF closure in pediatric patients.
  • To evaluate the impact of postoperative care, including intubation duration, on TCF repair outcomes.
  • To identify factors influencing the selection of surgical repair techniques.

Main Methods:

  • Retrospective chart review of 98 pediatric patients with persistent TCF.
  • Surgical management included tract excision with secondary intention (18 patients) or primary closure (80 patients).
  • Postoperative care varied: 18–24 hours intubation (63 patients) versus immediate extubation (17 patients).

Main Results:

  • Both secondary intention and primary closure methods demonstrated effectiveness in TCF repair.
  • No significant correlation was found between the surgical repair method and patient outcomes.
  • Postoperative intubation duration did not significantly impact TCF repair success rates.
  • Complications were minimal, with one tracheal granuloma and three patients requiring reoperation.

Conclusions:

  • Surgical repair of pediatric tracheocutaneous fistula, via primary closure or secondary intention, is a safe and effective procedure.
  • The choice of surgical technique and postoperative intubation strategy does not appear to significantly influence outcomes.
  • Preoperative assessment is crucial for selecting the most appropriate repair method for each pediatric TCF case.

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