Fistula In Pediatric Patient Research Articles

Clinical features, diagnosis, and treatment of different types of congenital preauricular fistulas in pediatric patients.

The aim of this study was to summarize the clinical features of congenital preauricular fistula (CPF) in pediatric patients to improve the levels of diagnosis and treatment, reduce the rates of missed diagnosis and recurrence, and shorten the total diagnosis and treatment time. A total of 353 patients with CPF who were admitted to the Department of Otolaryngology in The Children's Hospital, Zhejiang University School of Medicine between January 2019 and December 2021 was enrolled in this retrospective observational study. Follow ups for 12-42 months were performed to investigate the classification, surgical methods, and postoperative conditions of CPF and to compare the recurrence rate, complication rate, and total diagnosis and treatment time between the active infection CPF group (AICPFG) and infection-controlled/non-infected CPF group (IC/NICPFG). In 316 cases (89.5%) out of the 353 patients, the natural fistula orifice was located in front of the crus helicis; in 33 cases (9.4%), the natura fistula orifice was located at the crus helicis; and in 4 cases (1.1%), the natura fistula orifice was located in the external acoustic meatus. The AICPFG had 52 cases (14.7%), including 1 case (0.28%) of recurrence and 2 cases (0.56%) of infection at the incision site. The IC/NICPFG had 301 cases (85.3%), including 4 cases (1.13%) of recurrence, 6 cases (1.7%) of infection at the incision site, and 1 case (0.28%) of scar formation at the incision site. There were no significant differences in the recurrence rates and postoperative complications between the AICPFG and IC/NICPFG (p>0.05). There was a statistically significant difference in the total diagnosis and treatment time between the AICPFG and IC/NICPFG (p<0.05). A reasonable classification of CPF, use of appropriate surgical methods, and belonging to the AICPFG do not increase the recurrence and complication rates of children but shorten the total treatment course, relieve patients' suffering, reduce treatment costs, and achieve a better clinical prognosis.

Minimally invasive resection of congenital tracheobiliary fistula with thoracoscopic cholangiography

Minimally invasive resection of congenital tracheobiliary fistula with thoracoscopic cholangiography

Primary versus secondary closure of tracheocutaneous fistula in pediatric patients

ObjectiveUp to 50% of pediatric patients have a persistent tracheocutaneous fistula (TCF) after tracheostomy decannulation. Classically these fistula tracts were excised and completely closed in a multilayered fashion, but recently closure by secondary intention has become the standard of care. However, variations in postoperative care still exist. The primary objectives of this study were to compare outcomes between patients who had a primary closure versus closure by secondary intention after excision of a TCF in children with a tracheostomy placement at one year old or less and to determine if closure by secondary intention will be equally efficacious compared to traditional primary closure. MethodsPatients ages 0-21 years who had a primary or secondary closure of a TCF at a tertiary care children's hospital following decannulation of a tracheostomy tube were reviewed and those with a tracheostomy placement ≤1 year old were included. Demographic information, comorbidities, and surgical information were extracted from inpatient and outpatient charts. Mann-Whitney U test, Fisher's Exact test, and logistic regression to compare outcomes across the two TCF surgical groups. ResultsA total of 64 patients met inclusion with primary closures in 25 (39.1%) patients and secondary closures in 39(60.9%) patients. Patients who underwent secondary closure had a significantly shorter surgery duration (p < .001), shorter ICU length of stay (p < .001), and shorter postop LOS (p < .001). There were no differences in cardiac complications, respiratory complications, and the need for additional closure surgery between the two techniques, p > .05. Time from decannulation to TCF in months increased with primary closure, p = .010. ConclusionClosure of tracheocutaneous fistula by secondary intention is safe and effective and can allow for shorter hospital stays in children with a tracheostomy placement at a year old or less.

Primary versus modified secondary closure techniques for persistent tracheocutaneous fistula in pediatric patients.

This study aimed at compating two closure techniques for tracheocutaneous fistulas (TCFs) in pediatric patients. A total of 106 consecutive pediatric patients who underwent closure of a persistent TCF between April 2007 and February 2021 at a tertiary pediatric hospital were evaluated, and 103 pediatric patients aged between 12months and 18years were included. The clinical characteristics, perioperative outcomes, and postoperative outcomes were compared between TCF closure by primary closure (Group 1) and a modified secondary healing technique (Group 2). Of the 103 patients, 58 were classified into Group 1, and 45 into Group 2. The mean age at tracheostomy and TCF closure was significantly younger in Group 2, and the interval between decannulation to TCF closure was significantly shorter in Group 2. Procedural time and hospital stay were significantly shorter in Group 2 than Group 1. Group 2 had a significantly lower complication rate, need for revision surgery, and recannulation rate than Group 1. Modified secondary healing was more efficient in terms of procedural time and hospital stay, and safer (i.e., fewer complications). It is an effective surgical technique for closing a persistent TCF in younger patients more quickly after decannulation compared to primary closure.

Congenital coronary artery fistula in pediatric patients: transcatheter versus surgical\xa0closure

ObjectivesTranscatheter closure (TCC) and surgical closure (SC) are the two main approaches for congenital coronary artery fistula (CCAF), but data on the comparisons of the efficacy and safety of these two approaches are limited.MethodsWe retrospectively reviewed pediatric patients with CCAF in Guangdong Cardiovascular Institute between January 2002 and December 2017. Patients who were qualified into our criteria were included into final analysis. The rate of successful closure and complications during hospitalization and at follow-up were compared between SC and TCC groups.ResultsIn total, 121 pediatric patients (male, n = 69; female, n = 52) with CCAF were divided to TCC (n = 63) and SC groups (n = 58) according to the indications. The mean age was 5.3 ± 1.4 years. The baseline characteristics of these two groups were similar except for the fistula anatomic feature. After adjusted for the fistula anatomy, compared to SC, TCC was associated with higher risk of major complications (p = 0.013). Proportions of patients requiring blood transfusion and intra-operative blood loss were higher in SC versus TCC groups, as were longer duration of hospital and ICU stay during hospitalization. In contrast, myocardial ischemia (10.2% vs 0.0%, p = 0.028), residual shunts (16.9% vs 3.6%, p = 0.045) and new-onset moderate-to-severe valve regurgitation (11.9% vs 0.0%, p = 0.013) were higher in TCC group versus SC groups during follow-up.ConclusionsTCC has less invasive and faster recovery. However, SC had a higher successful rate and lower risk of major complications in pediatric patients.

Reoperation for Pyriform Sinus Fistula in Pediatric Patients.

Introduction: The aim of this study was to analyze the authors' experience in re-operative surgery for children with pyriform sinus fistula (PSF) who were subjected to attempted but failed operations.Methods: We retrospectively analyzed the medical records of 30 patients with PSF who underwent reoperation (i.e., a revision of the primary performed definitive procedure) from January 2010 to December 2018.Results: There were 19 boys and 11 girls. Twenty-nine cases were left-sided. The median age of the patients when they underwent the primary operation was 5.5 years (range, 15 days−14 years). Five children received two definitive procedures from outside hospitals. The primary operations included traditional open-neck surgery (n = 30), endoscopic-assisted open-neck surgery (n = 4), and endoscopic laser cauterization (n = 1). The median time from primary operation to recurrence was 4 months (range, 1 month−4 years). The reasons for recurrence were incomplete resolution of infection (n = 7), incomplete resection of the fistula (n = 23), cauterization of PSF inner orifice (n = 1), only cyst excision in neonates (n = 2), and unknown (n = 2). All 30 children underwent endoscopy-assisted open-neck surgery. The median age of the children when they underwent reoperation was 8 years (range, 2–17 years). The fistula was detected in 29 cases (96.7%). After reoperation, good outcome was achieved in 27 patients (90%). Wound infection developed in one case. PSF recurred in two cases (6.7%).Conclusion: Most of the recurrences observed by us are preventable. Complete resolution of infection, clear verification, and exact resection of the fistula at a high level are essential for preventing recurrence. Endoscopy-assisted surgery is effective for PSF reoperation.

Giant choledochal cyst presenting as cholecystocolonic fistula: A rarity

Cholecystoenteric fistula is a rare entity, which is seen in cholecystitis complicated with cholangitis. The incidence of such fistula in pediatric patients with the choledochal cyst is extremely rare. Here, we report one such case of choledochal cyst in which cholecystoenteric fistula was detected intraoperatively.

Initial Experience with Fibrin Glue Treatment of Anal Fistulae in Children

Pediatric anal fistulae commonly result from recurrent perianal abscesses, of which nearly 50 per cent develop an anal fistula. The purpose of this study was to report the results of using fibrin glue to treat anal fistula in pediatric patients. Infants and children with recurrent perianal abscesses and anal fistulae were treated with either fistulectomy or fibrin glue. Demographic and clinical characteristics and outcomes were compared between the groups. A total of 34 children were included; 27 received fistulectomy (median age eight months) and seven received fibrin glue treatment (median age 14 months). No significant differences in demographic or clinical characteristics were found between the two groups (all, P > 0.05). Median follow-up duration was significantly higher in the fibrin glue group compared with that in the fistulectomy group (five months vs one month, P = 0.003). There was one recurrence in the fistulectomy group, and no recurrences in the fibrin glue group (P = 1.0). No complications occurred in either group. Fibrin glue treatment is a simple and effective treatment alternative in the management of anal fistula in children, offering the advantage of sphincter muscle-sparing and reduced risk of fecal incontinence.

Outcomes of surgical repair of pediatric coronary artery fistulas

ObjectiveIsolated congenital coronary artery fistula is a rare condition, and the surgical experience for treating this condition is limited. MethodsThis was a retrospective review of 47 patients who underwent surgical repair of isolated congenital coronary artery fistula from January 2001 to March 2015. ResultsAll but 1 patient presented with no symptoms. The median age at operation was 3.9 years (range, 0.4-15.2 years), and the median weight was 15.2 kg (range, 6.3-77.0 kg). Right coronary artery to right ventricle fistula was the most common pattern, which was present in 16 patients. Epicardial ligation without cardiopulmonary bypass was used to treat 4 patients, whereas cardiopulmonary bypass was used in the remaining 43 patients. Surgical techniques included transcoronary closure in 20 patients, transcameral or transpulmonary closure in 20 patients, a combination of both transcameral and transcoronary closure in 2 patients, and a conversion from transcameral closure to epicardial ligation in 1 patient. There were no deaths during our study period. Injury to the mitral valve occurred in 1 patient. Residual shunt was observed in 8 patients, 2 of which closed spontaneously during the follow-up. Extracardiac repair was associated with a higher risk of recanalization (P = .004). Freedom from recanalization was 89.4%, 85.1%, 83.0%, and 83.0% at discharge, 6 months, 1 year, and 5 years postsurgery, respectively. Two patients required transcatheter closure for residual shunts. ConclusionsSurgical repair of isolated congenital coronary artery fistula in pediatric patients can be performed with low mortality and morbidity. Careful evaluation after surgery is necessary to monitor the occurrence of residual shunt.

The diagnosis and management of an iatrogenic esotracheal fistula in a pediatric patient: Case report

Iatrogenic esotracheal fistula in pediatric patients is an extremely rare complication, and appears either because of the pressure exercised by the tracheostomy cannula or in patients that are long-term bearers of esogastric tubes, which will cause, together with the cannula, ischemic injuries and necrosis of the tissue. The treatment of these lesions is controversial. The paper presents the management of a pediatric patient with an acquired esotracheal fistula, secondary to a tracheostomy.

Slide tracheoplasty for the treatment of tracheoesophogeal fistulas

PurposeThe purpose of this study is to determine the surgical outcome of slide tracheoplasty for the treatment of tracheoesophageal (TE) fistula in pediatric patients. MethodsAfter internal review board approval, the charts of pediatric patients (0–18years old) who had undergone slide tracheoplasty for tracheoesophageal fistula were retrospectively reviewed. Patient information and surgical outcomes were reviewed. ResultsNine patients underwent slide tracheoplasty for correction of TE fistula. In five patients the original TE fistula was congenital. Other causes included battery ingestion, tracheostomy tube complications, foreign body erosion, and an iatrogenic injury. The average age at repair was 48±64 months (range: 1–190). Seven patients had undergone previous TEF repair either open or endoscopically. There were no recurrences after repair. Two patients had sternal periosteum interposed between the esophagus and trachea. There were no TEF recurrences. A single patient had dehiscence of the tracheal anastomosis and underwent a second procedure. ConclusionSlide tracheoplasty is an effective method to treat complex TE fistulas. The procedure was not associated with any recurrences. This is the first description of a novel, effective, and safe method to treat TE fistulas.

Reporte de caso y revisión de la literatura. Manejo endoscópico de fístula traqueoesofágica recurrente con electrocauterio y pegante tisular

Las fístulas traqueoesofágicas recurrentes (FTER) continúan siendo un reto terapéutico debido a las altas tasas de morbilidad y mortalidad asociadas con su manejo quirúrgico abierto y su recurrencia frecuente. Las técnicas endoscópicas aportan un abordaje alternativo con el potencial de mejorar los resultados y desenlaces quirúrgicos. Se presenta un caso de cierre o reparo endoscópico de FTER mediante el uso de broncoscopia y esofagoscopia, así como una combinación entre técnica con electrocauterio y pegante tisular. Se considera que esta técnica puede representar una alternativa válida para el manejo de esta patología. Igualmente, se señala la importancia de considerar la fístula traqueoesofágica un diagnóstico diferencial en pacientes pediátricos con infecciones respiratorias recurrentes.

Primary closure of persistent tracheocutaneous fistula in pediatric patients

Objective The aim of the study is to review the safety and efficacy of partial fistulectomy with 3-layered primary closure without postoperative intubation for persistent tracheocutaneous fistula (TCF). Design This is a retrospective study. Setting The study was conducted in a tertiary care pediatric hospital. Patients Records of 49 children treated for persistent TCF between 1996 and 2005 were reviewed. Patients were studied if the TCF was closed using a 3-layered primary closure, and they had at least 1 year of follow-up. Thirty-nine patients met inclusion criteria. Results All patients were extubated immediately after surgery. Drains were removed, and all patients were discharged on the first postoperative day. The most common indications for tracheostomy were prolonged intubation and subglottic stenosis. There were 2 major and 3 minor complications. One major complication involved subcutaneous emphysema that developed on the seventh postoperative day because of cough. The other involved a poorly controlled diabetic patient who developed a postoperative infection with dehiscence. All fistulas remained closed at follow-up. Conclusion Partial excision and primary closure of persistent TCF is safe and effective. Drain placement and overnight observation are imperative. Careful patient selection is important. Routine postoperative intubation is not necessary.

Echocardiographic Evaluation of Coronary Artery Fistula in Pediatric Patients

The management of pediatric patients with coronary artery fistula (CAF) remains controversial because the clinical course of CAF may vary greatly from spontaneous closure to severe complications. The purpose of our study was to report the outcome of CAF in pediatric patients by using echocardiography as an evaluation tool. Between January 1997 and July 2003, 17 patients (age range, 5 months to 14 years; mean, 3.8 years) with coronary angiographically proven CAF were recruited. We divided patients into two groups. Group 1 (n = 4) included patients with symptoms related to CAF (n = 3), persistent coronary artery dilatation for 6 months (n = 4), and/or a continuous waveform of the fistula detected by Doppler (n = 3). Group 2 (n = 13) included patients who were asymptomatic, with normal coronary artery size or coronary artery dilatation less than 6 months, and/or a noncontinuous waveform of the fistula detected by Doppler. Group 1 patients received interventional therapy, whereas group 2 patients were managed conservatively. There were 6 male and 11 female patients. The correlation coefficient of coronary artery diameter measured on echocardiography and angiography was 0.935 and 0.834 in groups 1 and 2, respectively. The diameter of the involved coronary artery was 5.8-9.2 mm (mean, 7.50 +/- 1.85) and 1.7-3.8 mm (mean, 2.72 +/- 0.59) in group 1 and group 2, respectively. After transcatheter coil embolization, group 1 patients became asymptomatic with no residual fistula and had decrement of the coronary artery diameter (p = 0.035). All group 2 patients remained asymptomatic with no significant change in coronary artery size (p = 0.846) and 3 of them showed spontaneous closure of CAF. Persistent dilatation of the diameter of proximal coronary artery may be a useful parameter for determining subsequent application of interventional therapy. In patients with nonsignificant CAF, conservative follow-up is strongly suggested and intervention procedures may be unnecessary.

Complications of surgical closure of tracheo-cutaneous fistula in pediatric patients — two case reports

Tracheocutaneous fistula is seen frequently in decannulated children and respiratory complications associated with primary surgical closure can be potentially fatal. Cough is a precipitating factor for an air leak and we report two cases in which this occurred. A tracheotomy was performed on a 5-month-old girl for mechanical ventilation. Decannulation was successful at the first attempt. One year later, she presented with a persistent tracheo-cutaneous fistula. After surgical closure without drainage, she developed subcutaneous emphysema during a coughing episode. Sutures were removed. A 9-month-old boy presented with oxygen-dependence after lung disease and a tracheotomy was performed for respiratory support. Decannulation was successful at the first attempt 6 months later. He developed a pneumomediastinum after surgical closure of a tracheo-cutaneous fistula. Sutures were removed but replacement of a tracheotomy tube was required. In both cases the wounds were allowed to heal by secondary intention.