Management of persistent tracheocutaneous fistula in children: Survey among paediatric otorhinolaryngologists

Introduction

Persistent tracheocutaneous fistula (TCF) is a common sequelae following paediatric tracheostomy, often leading to significant morbidity for both the child and their caregivers. Its presence can result in chronic airway issues, increased risk of infection, impaired phonation, cosmetic concerns, and a substantial psychosocial burden for families. We aim to evaluate the current practices, preferences, and variations among paediatric otorhinolaryngologists worldwide in the management of persistent (TCF) in children to identify areas of consensus and gaps that may guide future standardisation of care.

Methods

A 24-item cross-sectional survey was developed and distributed via a global WhatsApp™ group of paediatric otorhinolaryngologists between July and August 2024. The survey assessed surgical preferences, timing of intervention, preoperative investigations, and postoperative care. Descriptive statistics and chi-square tests were used to analyse practice variations based on years of experience and surgical preferences.

Results

Out of 319 members invited to participate, 121 paediatric otorhinolaryngologists completed the survey, yielding a response rate of 37.9 %. 121 Paediatric Otorhinolaryngologists answered the survey. Respondents were from six different continents, with the majority from Europe, 43 %. 68.6 % of the respondents have been practising for more than 10 years. The mean of tracheostomies performed in a year among the respondents was 10.6 per year. 46.5 % of respondents preferred primary closure and healing by secondary intention by 46.5 %, while 7 % preferred both surgical techniques. Airway assessment will be performed by 87 % of the respondents before the closure of TCF. The surgeons who performed more tracheostomies were found to prefer primary closure (p = 0.034). Choice of closure was not associated with years of experience, place of practice, underlying comorbidities, and investigations performed (p > 0.05).

Conclusion

There is significant variation in the management of persistent TCF among paediatric otorhinolaryngologists. Primary closure and healing by secondary intention were equally favoured, with surgical choice influenced by patient-specific factors, institutional resources, and regional practices, although surgeons who perform more tracheostomies prefer primary closure of TCF. Preoperative airway assessment was widely adopted, but postoperative follow-up protocols varied. Given the lack of standardised guidelines, a multicentre prospective study is warranted to establish evidence-based recommendations for optimal TCF management.Level of Evidence: V.