Prevalence and Predictors of Revision Endoscopic Suture Repair of Type I Laryngeal Clefts

Introduction: Endoscopic suture repair (ESR) of type one laryngeal clefts (LC-1) is a common surgical intervention for pediatric aspiration, but persistent dysphagia is common, and many children require revision surgery. The purpose of this study was to quantify the prevalence of revision ESR of LC-1 and determine whether various medical, socioeconomic, and surgical factors are associated with the need for revision.

Methods: This was a retrospective cohort study of all children ages 5mo-18 years undergoing ESR of LC-1 at a single tertiary care institution from July 2015-June 2025. Outcomes assessed included need for revision surgery in the study period and post-op videofluoroscopic swallow study (VFSS) outcomes, specifically the recommended liquid thickness (RLT) to avoid aspiration. Potential risk factors included age at revision, insurance type (Medicaid or private), pre-operative VFSS assessment, and surgical technique (cold steel vs CO2 laser).

Results: Between 2015-2025, 450 children underwent ESR with a revision rate of 11%. Patients requiring revision were slightly younger (median age =1.8 years) than patients not requiring revision (age = 2.0 years), p = 0.04. The median age at revision was 3.4 years, and most revisions were done within 3 years of the original surgery (86%). There were no meaningful differences between groups based on gender or insurance type. Among various comorbidities, only sleep disordered breathing (SDB) was more common in the revision group (49% vs 27%, p = 0.003). Other comorbidities that were more common in the revision group but did not achieve statistical significance included Trisomy-21, other chromosomal anomalies, eosinophilic esophagitis, and hypotonia. Patients in the revision group also had worse baseline swallow function. Cold steel repairs were less likely to need revision than those done with with CO2 laser (p=0.03) though this may be a reflection of other temporal trends.

Conclusions: In this study, we found that younger age, worse baseline swallow function, SDB, and CO2 laser mucosal ablation were associated with need for revision ESR.