Endoscope-assisted surgery for pyriform sinus fistula in children over 13 years: a review of 147 cases at a single institution

Abstract

Objective Congenital pyriform sinus fistula (PSF) is relatively rare,but it often presents diagnostic and therapeutic challenges.Here we reported our experience of endoscope-assisted surgery for pediatric PSF.Methods Since 1999,a total of 147 children (90 males,57 females) with PSF had been enrolled.Their clinical manifestations included recurrent lateral neck infection,neck mass and respiratory distress.Preoperative examinations included barium enema,ultrasound,computed tomography and thyroid scan.After treatment and resolution of infection; fistula was demonstrated endoscopically.With a callback after a week,they were followed up for 3-157.2months.Results The age-of-onset ranged from the first day of life to 13.83 years (mean,3.7 years).It took 6 days to 178 months (mean,32.0 months) to diagnose from the age-of-onset.The average operative age was 5.5 years (17 days to 15 years).And 138 openings of PSF were located at left side,7 right and 2 bilateral.And 17 of them presented a large cervical cyst.Gastroscopy was successfully conducted in 143 cases (97.3％).The fistula traversed posterioinferior cornu of thyroid cartilage (n =34),anterior (n =14) and inferior (n =12).Esophageal injury occurred in 2 cases.One patient developed postoperative hoarseness.Recurrent PSF was found in 5 cases.Two of them were cured by re-excision.Another 3 remained asymptomatic for 6.3 to 97.7 months.The remainder recovered well during the follow-up.Conclusions PSF is not as rare as expected.And a higher index of suspicion for PSF should be raised in the management of neck lesions in children.With the aid of endoscope,PSF excision may be easier,more precise and less traumatic. Key words: Cysts; Neck; Gastroscopy