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Safia A, Abd Elhadi U, Bader R, Khater A, Karam M, Bishara T, Massoud S, Merchavy S, Farhat R. Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis. J Clin Med 2024; 13:5652. [PMID: 39337140 PMCID: PMC11433179 DOI: 10.3390/jcm13185652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 09/06/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
The removal of foreign bodies (FBs) from the airways of children is a critical procedure that can avert serious complications. While both flexible and rigid bronchoscopy techniques are employed for this purpose, their comparative efficacy and safety remain subjects of debate. Therefore, we conducted this investigation to compare between both procedures. Studies comparing flexible to rigid bronchoscopy (n = 14) were identified by searching PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. We performed comparative meta-analyses of reported presentation characteristics and clinical outcomes, using fixed- and random-effects models. A diverse range of FB types and locations were identified. No difference was observed in the success rate of FB removal between flexible and rigid bronchoscopy (logOR = 0.27; 95%CI: -1.91:2.45). The rate of negative first bronchoscopy was higher in the flexible compared to the rigid group (logOR = 2.68; 95%CI: 1.68:3.67). Conversion rates to the alternative method were higher in the flexible bronchoscopy group. The overall complication rates were similar between both methods; however, the risk of desaturation was significantly lower with flexible bronchoscopy (logOR = -2.22; 95%CI: -3.36:-1.08). Flexible bronchoscopy was associated with a shorter length of hospital stay. The choice of bronchoscopy technique should be tailored to individual case characteristics.
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Affiliation(s)
- Alaa Safia
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
- Research Wing, Safed 1311001, Israel;
| | - Uday Abd Elhadi
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
- Research Wing, Safed 1311001, Israel;
| | | | - Ashraf Khater
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
| | - Marwan Karam
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
| | - Taiser Bishara
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
| | - Saqr Massoud
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
| | - Shlomo Merchavy
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
| | - Raed Farhat
- Head & Neck Surgery Unit, Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel; (U.A.E.); (A.K.); (M.K.); (T.B.); (S.M.); (S.M.); (R.F.)
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Zhi-Pan T, Qi L, Xiao-Fei S. Three different surgical methods of the special tracheobronchial foreign body (pen cap) in children: Case series. SAGE Open Med Case Rep 2024; 12:2050313X241241216. [PMID: 38524381 PMCID: PMC10958796 DOI: 10.1177/2050313x241241216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
We present three novel cases of tracheobronchial foreign bodies (TFBs) in children caused by pen caps. One was removed by the rigid bronchoscopy successfully, the second was removed by rigid bronchoscopy combined with tracheotomy, and the last one was treated by bronchotomy from an external thoracic approach. Rigid bronchoscopy is the most widely used for treating TFBs in clinics, especially treating large and special foreign bodies, because rigid bronchoscopy can provide a good view for observation and operation. Successful removal of a foreign body under rigid bronchoscopy (an experienced doctor, suitable instruments, etc.) can obviate tracheotomy/tracheostomy or thoracotomy/bronchotomy.
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Affiliation(s)
- Teng Zhi-Pan
- Department of Otorhinolaryngology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Shen Xiao-Fei
- Shen Xiao-Fei, Department of Otorhinolaryngology, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, Jiangsu 210008, China.
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