DISCUSSION:
Flexible bronchoscopy has become a common practice for the removal of inhaled FB in adults, due to safety profile and high successful rate of the procedure. The limitations of equipment’s size in the pediatric population made this procedure less abundant. Lately, more studies were published, regarding children, with high successful rate, and high safety profile. As far as we know, this is the first study aimed to compare those two procedures, flexible versus rigid bronchoscopies, performed during the same period, under the same conditions. Our results strengthen the conclusion that flexible bronchoscopies are highly efficient and safe procedure in the removal of FB among children. In the cases that flexible bronchoscopy was not successful, the FB (metal pin) were removed by rigid bronchoscopy during the same procedure. Therefore, in a case of inhaled metal pin or other slippery objects (piece of glass, plastic pen cover), we recommend a combination of the two procedures in the operation room, with immediate backup of rigid bronchoscopy. Our results demonstrate the trend towards using flexible bronchoscopy as the primary method in pediatric population, as presented by the elevated rate during 2017 and so on (figure 2). Our results also support the notion that removal of FB by a flexible bronchoscopy is an upcoming technique, and like every new technique, has a learning curve. High successful rate, low complication rate and shorter length of procedure emphasize the experience of performer achieved over time. Regarding LOS, although the procedure was significantly shorter by flexible bronchoscope, there was no difference in LOS, probably reflecting the fact that length of hospitalization is determined by different medical and non-medical parameters.
Our main limitation is the retrospective nature of our study, with missing reported data in the patients’ files. For example the assisted tool that was used for removal was not documented in the majority of the files (77% and 35% of the rigid and flexible bronchoscopy, respectively).
Another important point is the procedure length; in our institution, while performing bronchoscopy in the operation room, the time is recorded from the minute the patient is entering the OR until the end of anesthesia. Of course, this time frame is much longer than the actual procedure itself. Since the study had compared the two procedures in similar conditions, this bias is applicable for both groups.
We recommend that flexible bronchoscopy will become the primary procedure for removal of FB in children, by experienced multidisciplinary team, in setting of the OR, with the backup of rigid bronchoscopy and ENT specialists.