Tracheocutaneous fistula closure in children.
OBJECTIVE
Systematic review of surgical techniques for tracheocutaneous fistula closure in children and successful closure or development of adverse events.


METHODS
PubMed, EMBASE, Web of Science, and Cochrane Library.


METHODS
A medical librarian was utilized to perform a systematic review.


RESULTS
Fourteen studies were identified. Eight studies reported outcomes for primary closure alone; one discussed results for secondary closure alone; and five included a combination of children who underwent either primary and secondary closure alone. No difference between surgical techniques was identified for effectiveness of closure (RR = 1.03, 95% CI: 0.97 to 1.10) and major (RR = 1.68, 95% CI: 0.56 to 5.05) or minor complications (RR = 1.28, 95% CI: 0.50 to 3.27). No mortalities were identified.


CONCLUSIONS
Both primary and secondary closure techniques for persistent tracheocutaneous fistulas in children are effective and associated with acceptable rates of complications. Given the available evidence, neither approach appears to be superior. Considerations for decision making in surgical approach may include family and social considerations, facility resource utilization, and cost differential. Further investigation may be directed at improving patient selection.
Pediatric Otolaryngology, Duke University Medical Center, Durham, NC, USA; Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA. Electronic address: jeffrey.cheng@duke.edu.
Jeffrey
J
Cheng
Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Hofstra Northwell School of Medicine, Hempstead, NY, USA.
Dhave
D
Setabutr
D002648:Child; D017577:Cutaneous Fistula / Q000150:complications / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D014133:Tracheal Diseases / Q000150:complications / Q000601:surgery*
Children; Fistulectomy; Pediatric; Primary closure; Secondary intention; Systematic review; Tracheocuteanous fistula