title: Surgical learning curve in performing palatoplasty: A retrospective study in 200 patients.
abstract: OBJECTIVE
  The aim of the study was to assess the influence of the experience of the surgeon on the occurrence of fistulas following palatoplasty.
  
  
  METHODS
  A retrospective review was performed of consecutive children treated between 2006 and 2013 for cleft palate by a single surgeon. Cleft palate repair was performed using the von Langenbeck technique, Furlow palatoplasty, buccal flap or Vomer flap. Data was collected for age, sex, date of birth, syndrome, adoption, cleft palate type, type of repair, cleft width, fistula occurrence and location of fistula.
  
  
  RESULTS
  A total of 276 operations were performed in 200 children (Veau I, II, III, IV). Mean age at surgery was 21.9 months (range: 6.2 months to 26 years 8.3 months). Postoperatively, palatal fistulas occurred in eight patients (4.0%), however, the incidence was 3.0% in the non-adoption group and 9.7% in the adoption population. In this study there was no statistically significant evidence of a surgical learning curve, and no significant associations between fistula rate and sex, adoption, syndrome, cleft type, cleft width, or type of repair.
  
  
  CONCLUSIONS
  This study demonstrates a fistula formation rate of 3.0% for the non-adoption population and 9.7% for the adoption population. There was no statistically significant evidence of a learning curve during the first few years of performing cleft palate repair. No other independent risk factors for postoperative fistula formation were identified; however, the benefit of a vomer flap and subsequent reduction in fistula incidence was demonstrated.
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands. Electronic address: bja.smarius@gmail.com.
authors.forename: Bram
authors.initials: B
authors.lastname: Smarius
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; Department of Plastic Surgery Meander Medical Center, 3813 TZ Amersfoort, The Netherlands.
authors.forename: Corstiaan
authors.initials: C
authors.lastname: Breugem
mesh_terms: D000293:Adolescent; D000300:Adoption; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D005402:Fistula / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D059032:Learning Curve; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010159:Palate; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Cleft fistula; Cleft palate closure; Learning curve; UCLP; Vomer flap