Determining Post-Operative Outcomes After Cleft Palate Repair: A Systematic Review and Meta Analysis

Publication date: Available online 5 September 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Michael J. Stein, Zach Zhang, Matthew Fell, Nigel Mercer, Claudia Malic

Abstract

Background

A lack of high level evidence exists on the outcomes of different cleft palate repair techniques. A critical appreciation for the complication rates of common repair techniques is paramount to optimize cleft palate care.

Methods

A literature search was conducted for articles measuring fistula and VPI rates following cleft palate repair. Study quality was determined using validated scales. The heterogeneity between studies was evaluated using I2. Random effect model analysis and forest plots were used to report pooled relative risks (RR) with 95% confidence intervals for treatment effect. P-values of 0.05 were considered statistically significant.

Results

Of 2386 studies retrieved, 852 underwent screening and 227 met inclusion criteria (130 studies (57%) on fistulas and 122 studies (54%) on VPI). Meta-analyses were performed using 32 studies. The Furlow technique is associated with less post-operative fistulae than the von Langenbeck and Veau/Kilner/Wardill techniques (RR=0.56[0.39–0.79],p<0.01 and RR=0.25[0.12–0.52],p<0.01 respectively). One-stage repair is associated with less fistulae compared to two-stage repair (RR=0.42[0.19–0.96],p=0.04). The Furlow repair was also associated with a less VPI than the Bardach palatoplasty (RR=0.41[0.23, 0.71],p<0.01) and the one-stage repair is associated with a reduction in VPI rates compared to two-stage repairs (RR=0.55[0.32, 0.95],p=0.03).

Conclusion

The Furlow repair is associated with less risk of fistula formation than the von Langenbach and Veau/Kilner/Wardill techniques and less VPI compared to the Bardach repair. One-stage repair is associated with less risk of fistula formation and VPI than two-stage repairs.