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Pediatric tracheostomy revisited: a nine-year experience using horizontal intercartilaginous incision
Jae-Jin Song1, Ik J Choi, Hyun Chang
1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
This study on pediatric tracheostomy shows a vertical skin incision and horizontal intercartilaginous incision technique is safe and effective, with fewer granulation tissue complications compared to literature.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Tracheostomy is a critical procedure for pediatric airway management.
- Conventional tracheostomy techniques carry potential complications.
- Evaluating novel surgical approaches is essential for improving patient outcomes.
Purpose of the Study:
- To detail a pediatric tracheostomy technique utilizing a vertical skin incision and horizontal intercartilaginous incision.
- To compare the postoperative outcomes of this technique with existing literature data.
Main Methods:
- Retrospective chart review of 111 pediatric patients undergoing tracheostomy.
- Analysis of demographics, diagnoses, indications, follow-up, decannulation, and complications.
- Comparison of results with a comprehensive literature review.
Main Results:
- The procedure was performed on 111 children for various airway issues.
- Early and late major complication rates were 2.7% and 12.6%, respectively.
- Significantly less stomal granulation tissue and a trend for less suprastomal collapse were observed compared to literature.
Conclusions:
- Pediatric tracheostomy with this specific incision technique is comparable to conventional methods regarding complication and mortality rates.
- The technique demonstrates potential benefits in reducing specific complications like granulation tissue formation.
- Further randomized controlled trials are recommended for direct comparison with conventional tracheotomy.
Objectives/Hypothesis:
To describe our tracheostomy procedure using a vertical skin incision and a horizontal intercartilaginous incision and to compare our postoperative results with those in the recent literature.
Study Design:
Retrospective chart review and literature review.
Methods:
One hundred eleven children underwent tracheostomy using a vertical skin incision and a horizontal intercartilaginous incision over a 9-year period. A retrospective chart review was undertaken with respect to the following variables: demographics, weight, primary diagnosis, surgical indication, follow-up duration, decannulation, interval between tracheostomy and decannulation, and complications experienced. In addition, the outcomes were compared to results from a literature review.
Results:
Of the 111 patients, 56 had a history of prolonged intubation, 52 had upper airway obstruction, and three underwent tracheostomy for tracheobronchial toileting. Three (2.7%) patients experienced early major complications without major sequelae, and 14 (12.6%) experienced late major complications. Twenty-one (18.9%) patients were decannulated during the follow-up period, whereas 17 (17.8%) died of their primary disease or tracheostomy-related complications (15 died of their primary disease and two died of tracheostomy-related complications). The complication rates showed overall no differences, but our patient series showed significantly less stomal granulation tissue formation and non-significant trend for less suprastomal collapse as compared with previous literature.
Conclusions:
Pediatric tracheostomy using a vertical skin incision and horizontal intercartilaginous incision is comparable with the conventional procedure in terms of complication and mortality rates. Future randomized controlled studies are mandatory to directly compare conventional tracheotomy using a vertical skin incision and a horizontal intercartilaginous incision with our procedure.
Level Of Evidence:
4.
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