Endoscopic carbon dioxide laser cauterization for congenital pyriform sinus fistula in children: a report of 19 cases

Abstract

Objective To evaluate the feasibility, advantages and disadvantages of endoscopic carbon dioxide (CO2) laser cauterization (ECLC) for congenital pyriform sinus fistula (CPSF) in children. Methods A total of 19 children of endoscopically confirmed CPSF sinus type underwent ECLC between January 2011 to October 2014. There were 8 males and 11 females with an average age of 58.3 (15-144) months. The lesions were located at left (n=16) and right (n=3) sides. The presentations included deep neck abscess (n=14) and acute suppurative thyroiditis (n=5). And 15 patients developed upper respiratory infection before an onset of initial symptoms. Preoperative examinations included barium swallow X-ray (BSX), computed tomography (CT) and magnetic resonance imaging (MRI). During acute infection phase, 13 patients underwent incision and drainage and antibiotics were used according to the results of antimicrobial susceptibility or amoxicillin plus clavulanic acid empirically. During quiescent period, the internal openings of CPSF were confirmed by suspension laryngoscopy and then ECLC on internal opening was routinely performed. Endoscopy was carried out 3 months later. And ECLC was indicated if internal opening was not complete closed. Results All patients were confirmed endoscopically. The closure rate of treatment after the first ECLC was 89.4% (17/19), the accumulative success rate after the second treatment 94.7% (18/19) and the accumulative success rate after the third treatment 100% (19/19). In 2 patients, incompletely closed orifices (without clinical symptoms) were identified and re-cauterized more than twice. Neither hoarseness nor cough occurred. There was no recurrence during an average follow-up period of 24.2(6-55) months. Conclusions Endoscopic CO2 laser cauterization is safe, mini-invasive, efficacious, cosmetic and repeatable so that it may become a first-line treatment for sinus type of CPSF in children. Key words: Fistula; Natural orifice endoscopic surgery; Laser therapy