Optimizing palatal fistula repair: CLAPP Hospital's institutional experience tracking success and recurrence in 510 cases over 3 years.

BACKGROUND

Palatal fistula repair remains a persistent challenge in cleft care, with recurrence rates ranging from 10% to 30% globally. Despite the numerous techniques described, outcomes remain variable. Therefore, identifying predictors of recurrence is critical to guide individualized, evidence-based surgical strategies.

METHODS

This retrospective observational cohort included 510 patients who underwent palatal fistula repair over a three-year period at a high-volume cleft center (CLAPP Hospital, Lahore, Pakistan). Patients were categorized as presenting with either primary or recurrent fistulae. Demographic, anatomical, and surgical variables were recorded. Predictors of recurrence were evaluated using univariate and multivariate logistic regression, with outcomes reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

Among 510 patients, 345 had primary fistulae and 165 had recurrent fistulae. The overall recurrence rate was 12.5%. Older age was significantly associated with recurrence on univariate analysis (median 12 vs. 7 years; p < 0.001) but did not remain significant after adjustment. Recurrent fistula at presentation independently predicted further recurrence (aOR 1.83, 95% CI: 1.01-3.30; p = 0.045). The Bardach two-flap repair, employed in 72.4% of the cases, was associated with higher recurrence compared to flap-based techniques (aOR 0.50, 95% CI: 0.24-0.96; p = 0.047). Larger size and greater anatomical extent were significant only in univariate analysis, indicating that appropriate surgical technique selection mitigated risk.

CONCLUSION

Recurrent fistulae and Bardach repair independently predicted recurrence, whereas flap-based approaches reduced failure rates. These findings reinforce the importance of risk-adapted surgical planning, intraoperative decision-making, and standardized treatment pathways. Multicenter registries and longer-term follow-up are needed to further optimize outcomes in palatal fistula repair.