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.