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Updated: Mar 21, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Systematic review of surgery for persistent pediatric tracheocutaneous fistula
Sean Lewis1, Hamid Arjomandi1, Richard Rosenfeld1
1Department of Otolaryngology-Head and Neck Surgery, State University of New York Downstate Health Science Center, Brooklyn, New York, U.S.A.
Insights
Surgical closure of persistent tracheocutaneous fistula (TCF) in children using primary closure or secondary intention yields similar high success rates and low complication rates. Both methods are effective for treating TCF in pediatric patients.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Thoracic Surgery
Background:
- Persistent tracheocutaneous fistula (TCF) is a challenging condition in pediatric patients.
- Surgical intervention is often required for TCF closure.
- Choosing between primary closure and secondary intention healing is a key surgical decision.
Purpose of the Study:
- To compare treatment outcomes and adverse event rates for primary closure versus secondary intention healing in pediatric TCF.
- To evaluate the effectiveness and safety of different surgical techniques for TCF in children.
Main Methods:
- Systematic review adhering to PRISMA standards.
- Searched MEDLINE, Embase, Cochrane Library, and conducted manual searches.
- Included case series and comparative studies of TCF surgery in children under 18; excluded case reports and studies with fewer than two patients.
- Utilized random effects meta-analysis for pooled data analysis.
Main Results:
- Analyzed 14 articles involving 413 patients (primary closure) and 233 patients (secondary intention).
- Pooled success rates: 95.7% for primary closure and 92.7% for secondary intention.
- No significant differences found between techniques for treatment success, overall complications, revision surgery, subcutaneous emphysema, pneumothorax, urgent airway problems, wound infection, or wound dehiscence.
Conclusions:
- Surgical closure of pediatric TCF by primary closure or secondary intention demonstrates comparable high success rates.
- Both techniques exhibit a low incidence of serious complications, including subcutaneous emphysema and airway issues.
- The choice of closure technique does not appear to impact treatment success or complication rates in pediatric TCF surgery.
Objectives:
To compare the treatment outcomes and adverse event rates for primary closure compared to simple excision with healing by secondary intention for persistent tracheocutaneous fistula (TCF) in children.
Study Design:
Systematic review.
Methods:
Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. MEDLINE, Embase, Cochrane Library, and manual search were used to identify articles. Inclusion criteria were case series or comparative studies of surgery for persistent TCF in children under age 18 years. Exclusion criteria were age 18 years or older, duplicate patient series, case series with less than two patients, or case reports. Data were pooled using random effects meta-analysis to assess outcomes, adverse events, and comparative effectiveness.
Results:
We identified 14 articles with 413 patients treated with excision with primary closure and 233 patients treated with excision with closure by secondary intention. Pooled success rates were 95.7% with primary closure (95% confidence interval [CI]: 93.1% to 97.4%) and 92.7% with secondary intention (95% CI: 88.4% to 95.4%). Subcutaneous emphysema or urgent airway problems were uncommon, occurring in 3.8% and 3.6% of patients, respectively. Five studies had data suitable for comparative meta-analysis, which showed no differences by closure technique for treatment success (P = .480), overall complications (P = .551), need for revision surgery (P = .624), or the incidence of subcutaneous emphysema or pneumothorax (P = .512), urgent airway problems (P = .126), wound infection (P = 1.00), or wound dehiscence or fistula (P = .818).
Conclusions:
There are no differences in the rates of success or complications with surgical closure of TCF in children, whether performed by primary closure or by secondary intention. Both techniques have high success rates with a low incidence of serious complications. Laryngoscope, 127:241-246, 2017.
