Primary closure of persistent tracheocutaneous fistula

Background: Tracheocutaneous fistula is a common sequela of long term tracheostomy and T-tube insertion. The presence of persistent tracheocutaneous fistula is more than a cosmetic problem to the patient, excessive secretion expelled from trachea can present a hygienic problem and embarrass social situation. Aspiration may occur and result in pneumonia. Dysphagia and phonatory problem are also noted. Therefore, surgical treatment is mandatory. Methods: Our series consisted of a retrospective review of primary closure of patients with persistent tracheocutaneous fistula at Chang Gung memorial hospital between January 1997 and February 1998. All patients received bronchoscopy before surgery to exclude any airway obstruction. Operation was performed under general anesthesia, and the steps included dissection, trimming and suture of tacheocutaneous fistula. Result: The mean patient age was 31, and the mean duration between decannulation and fistula closure was 7.1 months. One adult patient developed stridor after surgery, emergent tracheostomy was done and T-tube was reinserted. One pediatric patient developed infection and mild disruption of wound. Broad antibiotics were given and wound was completely healed. The postoperative course of other patients was smooth and the surgical wounds were in good cosmetic result. Conclusions: Surgical closure of persistent tracheocutaneous fistula is mandatory to decrease morbidity and increase life quality of patients. The advantages of primary closure include simple step, fast healing and good cosmetic result. This method is suggested to patients with careful preoperative evaluation and postoperative observation of airway to prevent complication.