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A simple method for closure of tracheocutaneous fistula in children
G R Licameli1, B R Marsh, D E Tunkel
1Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Insights
This study shows a simple surgical technique effectively closes persistent tracheocutaneous fistulas (TCF) in children. The multilayered closure method achieved an 88% success rate with no complications, offering a reliable pediatric TCF repair option.
Area of Science:
- Pediatric Otolaryngology
- Surgical Innovation
- Pediatric Airway Management
Background:
- Persistent tracheocutaneous fistula (TCF) is a challenging condition in pediatric patients.
- Previous TCF closure techniques may involve complex procedures or significant complications.
- A need exists for simple, reliable surgical methods for pediatric TCF repair.
Purpose of the Study:
- To evaluate the efficacy of a straightforward surgical technique for closing persistent tracheocutaneous fistulas in children.
- To assess the complication rate associated with this specific TCF closure method.
Main Methods:
- A retrospective case series was conducted at a tertiary pediatric otolaryngology center.
- Eight children (<18 years) underwent surgical closure of persistent TCF using multilayered closure of de-epithelialized local tissue.
- Tracheal dissection was avoided, and a thermal hemostatic scalpel was utilized for de-epithelialization and hemostasis in some cases.
Main Results:
- Nine procedures were performed in 8 pediatric patients.
- The primary surgical technique resulted in a successful closure in 7 out of 8 cases (88% success rate).
- One patient experienced early recurrence but was successfully treated with revision surgery and prolonged endotracheal intubation; no complications were reported.
Conclusions:
- The described multilayered closure technique is a simple and reliable method for managing persistent tracheocutaneous fistulas in children.
- This approach offers a favorable outcome with a high success rate and minimal complications.
- The technique avoids extensive tracheal dissection, making it a potentially safer option for pediatric TCF repair.
Objective:
To review the results of a simple technique of closure of persistent tracheocutaneous fistula (TCF) in children.
Design:
Retrospective case series.
Setting:
Tertiary pediatric otolaryngology referral center.
Patients:
Children (age, < 18 years) who underwent repair of TCF from July 1, 1991, to August 31, 1996.
Interventions:
Surgical closure of persistent TCF using multilayered closure of de-epithelialized local tissue. Tracheal dissection was not performed. A thermal hemostatic scalpel was used in some cases to assist in de-epithelialization and provide hemostasis without electrocautery near the airway.
Main Outcome Measures:
Success of closure and number and types of complications.
Results:
Nine procedures were performed in 8 children. Seven (88%) of 8 primary procedures were successful, but early recurrent TCF developed in 1 patient. Revision surgery using an identical surgical technique, but maintaining endotracheal intubation for 48 hours, was successful in this patient. No complications occurred.
Conclusions:
This procedure is a simple, reliable method for closure of TCF in children.