Tracheocutaneous Fistula Closure in the Pediatric Population: Should Secondary Closure Be the Standard of Care?

Abstract

Objectives: Tracheocutaneous fistula (TCF) closure is achieved by excision followed either by primary closure or healing by secondary intention. Although primary closure provides immediate resolution of the fistula, it is associated with more severe potential complications. Healing by secondary intention minimizes these potential complications; however, it is inconvenient for the patient and may be more likely to require revision surgery. We have had two life-threatening complications after primary closure, and this has raised the question of whether we should change our practice pattern. We wish to compare complication and success rates of the two methods in order to guide this decision. Methods: We conducted a retrospective study of 216 patients who underwent TCF closure in our academic tertiary care pediatric otolaryngology practice between 2004 and 2012. Results: Seventy percent of all fistulas closed by secondary intention. The complication and revision rates were not significantly different between the two methods (9% vs 11% and 9% vs 14%, respectively). Conclusions: TCF closure is accomplished by more than one method. In our study, we did not see any statistical differences between the two methods studied. We have only experienced life-threatening complicaitons when performing primary closure. Even though these complications are very rare, they are potentially disastrous. Given that both methods are equally efficacious, we recommend secondary closure as the standard of care for management of pediatric TCF.