Tracheocutaneous fistula closure in children

Objective: Systematic review of surgical techniques for tracheocutaneous fistula closure in children and successful closure or development of adverse events. Data sources: PubMed, EMBASE, Web of Science, and Cochrane Library. Review methods: A medical librarian was utilized to perform a systematic review. Results: Fourteen studies were identified. Eight studies reported outcomes for primary closure alone; one discussed results for secondary closure alone; and five included a combination of children who underwent either primary and secondary closure alone. No difference between surgical techniques was identified for effectiveness of closure (RR = 1.03, 95% CI: 0.97 to 1.10) and major (RR = 1.68, 95% CI: 0.56 to 5.05) or minor complications (RR = 1.28, 95% CI: 0.50 to 3.27). No mortalities were identified. Conclusions: Both primary and secondary closure techniques for persistent tracheocutaneous fistulas in children are effective and associated with acceptable rates of complications. Given the available evidence, neither approach appears to be superior. Considerations for decision making in surgical approach may include family and social considerations, facility resource utilization, and cost differential. Further investigation may be directed at improving patient selection. (C) 2016 Elsevier Ireland Ltd. All rights reserved.