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Published on: February 5, 2021

Posterior tracheopexy for pediatric tracheomalacia: A global evidence synthesis and meta-analysis

Sehajnoor Singh1, Dikshit Chawla2, M D Tályta Pessoa3

  • 1Sri Guru Ramdas Institute of Medical Sciences and Research, Sri Amritsar, India.

Journal of Pediatric Surgery
|July 6, 2026
PubMed

Insights

Posterior tracheopexy (PT) significantly improves respiratory symptoms and resolves overall symptoms in children with tracheomalacia (TM). This surgical approach leads to a near-elimination of cyanotic episodes and low reintervention rates with negligible mortality.

Area of Science:

  • Pediatric Surgery
  • Respiratory Medicine
  • Critical Care

Background:

  • Severe pediatric tracheomalacia (TM) causes dynamic expiratory airway collapse, leading to recurrent infections, respiratory support dependence, and significant morbidity.
  • Posterior tracheopexy (PT) is a reconstructive strategy for TM, but pooled outcome data are limited.
  • This study systematically reviews and meta-analyzes the efficacy and safety of PT in pediatric TM patients.

Purpose of the Study:

  • To evaluate the efficacy and safety of posterior tracheopexy (PT) in treating pediatric tracheomalacia (TM).
  • To assess key postoperative outcomes including symptom improvement, resolution, recurrent infections, and reintervention rates.

Main Methods:

  • A systematic review and meta-analysis of 14 observational studies involving 318 pediatric patients (<18 years) undergoing PT.
  • Searched major databases (PubMed, Embase, Scopus, Cochrane Library, Google Scholar) for relevant studies.
  • Utilized random-effects generalized linear mixed models to pool outcome proportions and assessed heterogeneity with I² statistics.

Main Results:

  • High rates of respiratory symptom improvement (91.03%) and overall symptom resolution (95.7%) were observed.
  • Significant reductions in blue spells/BRUEs (0.6%), recurrent infections (10.60%), and supplemental oxygen requirement (15.0%) were noted.
  • Low rates of reintervention (9.1%), acquired/recurrent TEF (5.7%), and overall complications (19.6%) were reported, with no perioperative mortality.

Conclusions:

  • Posterior tracheopexy (PT) is an effective treatment for pediatric tracheomalacia (TM), demonstrating high symptom improvement and resolution rates.
  • The procedure is associated with a near-elimination of cyanotic episodes, low reintervention rates, and minimal mortality.
  • Further prospective multicenter studies are needed to establish long-term durability and comparative effectiveness.
Abstract

Keywords:
Esophageal atresiaMeta-analysisPediatric airway surgeryPosterior tracheopexySystematic reviewTracheobronchomalaciaTracheoesophageal fistulaTracheomalacia

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