Early Outcomes and Complications of Primary Palatoplasty in a Resource-limited Setting: A Retrospective Study at Soba Teaching Hospital, Khartoum, Sudan

Abstract

Background: Cleft palate repair aims to restore palatal function while minimizing early complications that compromise healing and speech. Data from resource-limited settings remain limited. Methods: A retrospective cohort of consecutive patients undergoing primary palatoplasty at Soba Teaching Hospital, Khartoum, Sudan (between September 1, 2016 and March 31, 2017), with a 3-month follow-up, were included. Of the 70 screened procedures, 49 met inclusion criteria and were included in the analysis. Surgical technique (Bardach, Furlow, or von Langenbeck) and age at repair were considered. Outcomes considered were early wound dehiscence and/or oronasal fistula within 3 months; secondary outcomes included postoperative bleeding, respiratory obstruction, and flap necrosis. Analysis of absolute risks with 95% confidence intervals (CIs) and exploratory estimates of effects was performed. Results: Among 49 children (53.1% male; mean age, 44.1 ± 68.4 months; range, 6–324 months), dehiscence occurred in 6/49 (12.2%, 95% CI: 5.7 to 24.2) and fistula in 6/49 (12.2%, 95% CI: 5.7 to 24.2). Dehiscence varied by age group (peak 12–24 months: 29.4%) and by technique (Bardach 42.9%, Furlow 8.3%, von Langenbeck 6.7%). Fistula risk varied across cleft types (highest in unilateral cleft lip and palate [UCLP]) and techniques (0% with Bardach and Furlow vs 20.0% with von Langenbeck), with wide CIs due to the small number of events. No postoperative bleeding, airway obstruction, flap necrosis, or deaths were recorded (0/49; upper 95% CI: 7.3%). Conclusion: In this resource-limited setting, early complications occurred in approximately 1 in 8 children. Dehiscence appeared more common at 12–24 months and with Bardach; fistula showed center-specific heterogeneity, with no clear overall associations. Estimates are imprecise (small n, wide CIs) and susceptible to confounding by indication. Standardized perioperative protocols and earlier repair, where feasible, may reduce risk; prospective multicenter studies are warranted.