Primary vs. secondary closure of tracheocutaneous fistulas: A prospective cohort study

To prospectively compare outcomes and complications of the two most common techniques for closure of tracheocutaneous fistulas (TCFs): surgical excision of the tract with primary closure (PC), and de-epithelialization with healing by secondary intention (SI).

Prospective cohort study.

Tertiary academic center.

All patients who underwent closure of a TCF between 5/1/2022 and 5/30/2023 were eligible for inclusion in the study. Data was prospectively collected and included demographics, tracheostomy history, intraoperative data (including fistula size and closure technique), postoperative recovery and any complications.

There were 15 patients who underwent PC, and 10 patients who underwent closure by SI. Both cohorts were premature and had tracheostomies for at least 2 years prior to decannulation. The length of time from decannulation to closure was longer in the primary vs secondary group (p = .01). The operative time was significantly longer in the PC group (p = .002) and the PC group experienced a significantly higher number of postoperative respiratory complications (p = .05) during their postoperative admission. The average TCF size was larger in the SI group compared to the PC group (p < 0.001).

This prospective study demonstrated fewer postoperative respiratory complications for SI closure of TCFs compared to PC.