To review our experience with
cauterization of persistent tracheocutaneous
fistulas in children, we performed a retrospective review of patients who underwent
cauterization of tracheocutaneous
fistulas by the senior author (O.E.B.) from 1986 to 2001 in an academic, tertiary care children's hospital. We studied 13 pediatric patients ranging in age from 2.5 to 17.5 years of age at the time of surgery. Twelve patients underwent
cauterization under endoscopic visualization. One patient underwent superficial
cauterization of the tract without endoscopy. All patients had at least a 1-year history of an indwelling
tracheotomy. All patients were decannulated at least 1 year before
fistula cauterization. Of the 12 patients who underwent intraoperative airway endoscopy, the internal orifice of the
fistula tract was specifically visualized and seen to be patent in 10. One patient was noted to have internal mucosalization of the tract, and no discrete opening to the trachea was noted in the other patient. Eleven patients had complete closure of the
fistula site at follow-up (range, 2 weeks to 2 years). One patient developed a leak during a coughing spell 2 days after the operation, and the
fistula was noted to be closing with a small leak at follow-up. Another patient (with
Treacher Collins syndrome) ultimately required a repeat
tracheotomy for persistent
obstructive sleep apnea. This patient was the only one admitted after the operation, for a pulmonary infiltrate. No other patients required airway support in the immediate postoperative period.
Cauterization of tracheocutaneous
fistulas in children is a relatively simple, effective, and safe technique.