Outcome of Surgical Treatment for Tracheocutaneous Fistula in Paediatric Population: A Meta-Analysis

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2025-02-11 DOI:10.1111/coa.14292

Jeyasakthy Saniasiaya, Graeme van der Meer, Ed Toll, Craig McCaffer, Colin Barber, Michel Neeff, Md Asiful Islam

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引用次数: 0

Abstract

Objective

The incidence of persistent tracheocutaneous fistula (TCF) in children has dramatically increased with the increasing number of tracheostomies performed earlier in the paediatric population. Despite the various emerging techniques, two fundamental surgical approaches are primary closure and healing by secondary intention. We aim to compare the surgical outcomes between the two procedures.

Data Source

PubMed, EMBASE and Scopus databases were searched from inception to 31 December 2023 with no restrictions on the setting or design of studies.

Review Methods

Data were pooled using a random effects model to assess the success and complication rates between the two surgical techniques.

Results

A total of 26 studies were identified with a total of 1263 children. Persistent TCF was surgically treated with primary closure in 24 studies (n = 898), whereas healing by secondary intention was reported in 12 studies (n = 366). The success rate following primary closure and healing by secondary intention is 97.3% (95% CI: 95.7%–99.0%) and 94.0% (95% CI: 91.2%–96.7%), respectively. The pooled rate of complications following primary closure was 14.1% (95% CI: 8.9%–19.4%) and 8.4% (95% CI: 3.4%–13.3%) following healing by secondary intention.

Conclusion

Based on the pooled results, healing by secondary intention is a safer surgical option in children with persistent TCF.

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小儿气管皮瘘手术治疗的结果：一项荟萃分析。

目的：随着儿童早期气管切开术数量的增加，儿童持续性气管皮瘘（TCF）的发生率急剧增加。尽管出现了各种各样的新技术，但两种基本的手术方法是初级闭合和次级意图愈合。我们的目的是比较两种手术的手术效果。数据来源：PubMed、EMBASE和Scopus数据库从研究开始到2023年12月31日进行检索，对研究的设置和设计没有限制。回顾方法：采用随机效应模型汇总数据，评估两种手术技术的成功率和并发症发生率。结果：共纳入26项研究，共纳入1263名儿童。24项研究（n = 898）采用手术治疗持续性TCF，而12项研究（n = 366）报告了继发性愈合。初次闭合和二次意向愈合的成功率分别为97.3% （95% CI: 95.7%-99.0%）和94.0% （95% CI: 91.2%-96.7%）。初次闭合后并发症的总发生率为14.1% (95% CI: 8.9%-19.4%)，二次意向愈合后并发症的总发生率为8.4% （95% CI: 3.4%-13.3%）。结论：基于综合结果，对于持续性TCF患儿，继发性意向治疗是一种更安全的手术选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.