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Outcome of Surgical Treatment for Tracheocutaneous Fistula in Paediatric Population: A Meta-Analysis

Jeyasakthy Saniasiaya1,2, Graeme van der Meer1, Ed Toll1

  • 1Department of Paediatric Otolaryngology, Starship Children's Hospital, Auckland, New Zealand.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
|February 11, 2025
PubMed

Insights

Healing by secondary intention is a safer surgical option for persistent tracheocutaneous fistula (TCF) in children. This approach shows a lower complication rate compared to primary closure, making it a preferred choice for pediatric TCF treatment.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Wound Healing

Background:

  • Persistent tracheocutaneous fistula (TCF) incidence is rising in children due to increased tracheostomies.
  • Surgical management options include primary closure and healing by secondary intention.

Purpose of the Study:

  • To compare the surgical outcomes of primary closure versus healing by secondary intention for persistent TCF in children.
  • To evaluate success and complication rates for each surgical technique.

Main Methods:

  • Systematic review and meta-analysis of studies from PubMed, EMBASE, and Scopus databases.
  • Inclusion of 26 studies with a total of 1263 pediatric patients.
  • Random effects model used for pooling success and complication rates.

Main Results:

  • Primary closure (898 children) had a success rate of 97.3% and complication rate of 14.1%.
  • Healing by secondary intention (366 children) had a success rate of 94.0% and complication rate of 8.4%.
  • Healing by secondary intention demonstrated a significantly lower pooled complication rate.

Conclusions:

  • Healing by secondary intention is a safer surgical option for pediatric persistent TCF.
  • This approach offers a reduced risk of complications compared to primary closure.
  • Evidence supports secondary intention as a preferred method for managing TCF in children.
Abstract

Keywords:
childrenhealing by secondary intentionoutcomepersistent tracheocutaneous fistulaprimary closuretracheostomy

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