Furlow Versus Straight Line Repair With Intravelar Veloplasty: A 7-Year Single Institution Experience with Fistula Formation

Introduction: We aimed to characterize and identify potential risk factors for fistula formation including demographic variables, palatoplasty technique, Veau cleft classification, and adoption status at a large tertiary pediatric facility. Methods: Retrospective chart review was performed for patients undergoing primary palatoplasty via either Furlow or straight line with intravelar veloplasty (IVVP) technique from November 2011 to September 2018. Variables collected included age at time of surgery, gender, language, payer status, adoption status, syndromic status, presence of moderate and/or bilateral hearing loss, Veau cleft type, and presence of a postoperative fistula. Results: Of the 108 patients included, 34 underwent the Furlow procedure and 74 underwent the straight line repair procedure with IVVP. A significant correlation was found between fistula formation and both adoption status and Veau cleft type. Only patients with Veau cleft types 3 and 4 developed a postoperative fistula. Postoperative fistulae developed in 9 patients: 1/34 (2.9%) in the Furlow group and 8/74 (10.8%) in the straight line with IVVP group. Conclusions: At our institution, rate of fistula formation is not greatly different between Furlow and straight line with IVVP palatoplasty techniques despite their being a trend toward increased risk of postoperative fistulas within the latter group, supporting previous literature that did not find an association between technique and fistula rate. Veau cleft classification and adoption status were more closely associated with the formation of postoperative fistulae.

Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

Effect of collagen matrix on postoperative palatal fistula in cleft palate repair

Palatal fistula is a challenging complication following cleft palate repair. We investigated the usefulness of collagen matrix in the prevention of postoperative fistula. We performed a retrospective cohort study of patients with cleft palate who underwent primary palatoplasty (Furlow’s double opposing z-plasty) in Seoul National University Children’s Hospital. Collagen Graft and Collagen Membrane (Genoss, Suwon, Republic of Korea) were selectively used in patients who failed complete two-layer closure. The effect of collagen matrix on fistula formation was evaluated according to palatal ratio (cleft width to total palatal width) and cleft width. A total of 244 patients (male, 92 and female, 152; median age, 18 months) were analyzed. The average cleft width was 7.0 mm, and the average palatal ratio was 0.21. The overall fistula rate was 3.6% (9/244). Palatal ratio (p = 0.014) and cleft width (p = 0.004) were independent factors impacting the incidence of postoperative fistula. Receiver operating characteristic curve analysis showed that the cutoff values in terms of screening for developing postoperative fistula were a palatal ratio of 0.285 and a cleft width of 9.25 mm. Among nonsyndromic patients with values above those cutoffs, the rates of fistula development were 0/5, 1/6 (16.7%), and 4/22 (18.2%) for those who received Collagen Graft, Collagen Membrane, and no collagen, respectively. Collagen matrix may serve as an effective tool for the prevention of palatal fistula when complete two-layer closure fails, especially in wide palatal clefts. The benefit was most evident in Collagen Graft with thick and porous structure.