Tracheocutaneous Fistula Closure in Pediatric Tracheostomy Patients: A Systematic Review

Abstract

Objectives: Compare success and complication rates of primary tracheocutaneous fistula closure compared with fistulectomy with secondary fistula healing. Methods: A systematic literature search was performed on PubMed. All prospective and retrospective studies of tracheocutaneous fistula (TCF) closure techniques in pediatric patients were included for initial analysis. The authors’ unpublished cohort of 13 fistulectomy patients was also included in the overall analysis. Primary outcomes were surgical success rate and major complication rate. Fisher exact test was used for statistical analysis. Results: Thirteen studies were identified for inclusion in the systematic review; 8 studies reported both success rates and complications. The total number of patients in all included studies was 259 (median, 19; range, 8-98). Techniques included fistulectomy with multilayer closure (197), primary closure alone (2), and fistulectomy alone with healing by secondary intention (60). Success rates were comparable between fistulectomy alone (95.0%) and primary closure techniques (97.5%) ( P = .275). There was a statistically significant increased rate of reported major complications among patients treated with primary closure techniques compared to fistulectomy (0.0% vs 8.5%, P = .038). Conclusions: While both primary closure techniques and secondary healing techniques for pediatric TCF closure have excellent success rates, fistulectomy with healing by secondary intent is associated with less reported major complications.