Fistula In Children Research Articles

HIV-associated rectovaginal fistulae in children: a single-centre retrospective study in the antiretroviral era

PurposeAcquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition.MethodsWe retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011–2023). Information about HIV management, surgical history, and long-term outcomes was collected.ResultsTen patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1–3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5–55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3–25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05).ConclusionWhile HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.

Three-Decade Experience With Management of Coronary Artery Fistulas in Children

BackgroundThe treatment approach for coronary artery fistulas (CAFs) is debatable, and long-term outcomes are unknown. MethodsThis was a retrospective institutional data review of children in whom echocardiographically suspected CAFs were confirmed during cardiac catheterisation from 1997 to 2023. Treatment approach and outcomes were assessed. ResultsWe identified 94 CAFs in 78 patients (42.3% male), median age 3.4 years (interquartile range [IQR] 0.9-6.6 y). Twenty-five patients (32%) had other congenital anomalies; 41 (78.8%) of the 52 patients with isolated CAFs were asymptomatic. The most common site of CAF origin and drainage was the left system (62.8%) and right cardiac cavities (80.8%). Overall median follow-up was 101 months (IQR 41-185 mo); 23 patients (29.5%) with 35 (37.2%) small or nonshunting CAFs had conservative management, and 20 (87%) of those 23 patients had an uneventful follow-up; 8 patients (10.2%) with 9 (9.6%) complex CAFs were directly sent for surgery; 1 patient had early surgical patch failure needing surgical reintervention; 47 patients (60.3%) had catheter closure of 50 (53.2%) medium- or large-sized CAFs with the use of coils (30%), vascular plugs (20%), nitinol duct occluders (40%), or material combination (10%). Six serious complications occurred. Two of the 3 patients with unsuccessful catheter procedures had subsequent surgeries. Two of the 3 patients with mild shunts had successful redo closures. One asymptomatic patient had recanalisation after 12 years and is under watchful observation. ConclusionsCAFs have various anatomies and clinical presentations. Transcatheter closure is effective in carefully selected patients but is not complication free. Surgery is a valuable up-front option in complex CAFs or bailout of unsuccessful transcatheter closures, although it is not frequently used.

Role of Long-Chain Cyanoacrylate as an Adjunct Interposition Layer in Repair of Hypospadias and Urethrocutaneous Fistula in Children: A Novel Technique.

Purpose Hypospadias is an anomaly wherein the urethral opening is ectopically located on the ventral aspect of the penis. The most common complications after hypospadias repair are urethrocutaneous fistula (UCF) and meatal stenosis. Long Chain Cyanoacrylate (LCCA) tissue adhesive promises safety, feasibility, and durability due to its tensile strength and bacteriostatic and hemostatic properties. We conducted this study to ascertain whether LCCA tissue adhesive can prove a more effective adjunct to traditional suturing techniques. Methods Patients were divided into two groups. Group A underwent surgery with conventional reconstruction of the neourethral tube along with the buttressing layer using Buck's fascia or Tunica Vaginalis. In addition to the traditional procedure of GroupA, Group B patients were administered a layer of LCCA tissue adhesive as an adjunct between the neourethral suture line and the buttressing layer. Patients were followed up for six months and were evaluated for complications like UCF, meatal stenosis, hematoma, skin infection, glans dehiscence, and flap necrosis. Results Thirty-eight children in the age group 1-6 years were studied, of which 20 were in Group A and 18 in Group B. Among patients of Group A seven (35%)developed complications. In contrast, only four (22.2%)patients developed complications in Group B. The statistical significance in the complication rates between the two groups could not be achieved due to the modest sample size. However, the numerical and proportional reduction in the number of complications was noted. Conclusion LCCA adhesive as an adjunct numerically reduces the number of complications compared to traditional suturing alone in patients undergoing surgery for hypospadias and UCF.

Clinical Analysis of 76 Cases of Second Branchial Cleft Fistula.

Objective: To provide the experience of diagnosis and treatment of second branchial cleft fistula in children. Methods: The clinical data of 76 children with second branchial cleft fistulas admitted to Beijing Children's Hospital affiliated with Capital Medical University from January 2016 to December 2020 were retrospectively analyzed. All patients underwent cervical ultrasonography and resection of the second branchial cleft fistula, and their clinical manifestations, surgical methods, complications, recurrence condition, and lesion appearance of the patients were analyzed. Results: Among the 76 cases, the lesions of 43 cases were on the right side, 20 were on the left side, and 13 were bilateral, for a total of 89 lesions. There were 49 type I lesions, 28 type II lesions, 8 type III lesions, and 4 type IV lesions. Type I and type II cases underwent complete excision of the fistula through a small incision in the neck; 2 cases of type III branchial cleft fistulas were treated with trapezoidal incision; 2 cases of type III branchial cleft fistulas underwent single transverse incisions; single small incision-assisted endoscopic resection was adopted in 4 cases of type III and 4 cases of type IV branchial cleft fistulas. During the follow-up period of 6 to 60 months, only 3 cases developed postoperative infection, the others had no postoperative complications, and no cases had recurrence during postoperative follow-up. Conclusion: The incision of the second branchial fistula should be selected according to imaging examination to achieve removal of the fistula while maintaining esthetics.

Surgical Management of Coronary Artery Fistulas in Children.

This study investigated the surgical outcomes associated with coronary artery fistulas (CAFs) in children. We retrospectively reviewed the medical records of 23 pediatric patients who underwent surgical closure of CAFs between 1995 and 2021. At presentation, 7 patients (30.4%) exhibited symptoms. Associated cardiac anomalies were present in 8 patients. Fourteen fistulas originated from the right coronary artery and 9 from the left. The most common drainage site was the right ventricle, followed by the right atrium and the left ventricle. The median follow-up duration was 9.3 years (range, 0.1-25.6 years). The median age and body weight at repair were 3.1 years (range, 0-13.4 years) and 14.4 kg (range, 3.1-42.2 kg), respectively. Cardiopulmonary bypass was used in 17 cases (73.9%), while cardioplegic arrest was employed in 14 (60.9%). Epicardial CAF ligation was utilized in 10 patients (43.5%), the transcoronary approach in 9 (39.1%), the endocardial approach in 2 (8.7%), and other methods in 2 patients (8.7%). The application of cardioplegic arrest during repair did not significantly impact the duration of postoperative intensive care unit stay or overall hospital stay. One in-hospital death and 1 late death were recorded. The overall survival rate was 95.7% at 10 years and 83.7% at 15 years. A residual fistula was detected in 1 patient. During the follow-up period, no surviving patient experienced cardiovascular symptoms or coronary events. Surgical repair of CAF can be performed safely with or without cardioplegic arrest, and it is associated with a favorable prognosis in children.

A novel and efficient surgical procedure for pyriform sinus fistulas in children.

This study aims to evaluate the efficacy of a novel surgical procedure for pyriform sinus fistulas in children via the external cervical approach through the hypopharynx. A retrospective analysis was conducted on 71 pediatric patients with pyriform sinus fistula (PSF) who underwent treatment at the Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, from 2012 July to 2022 July. Surgical treatment of PSF was performed via the external cervical approach through the hypopharynx, with dye instilled through the internal opening to serve as a guide for tract identification. All the internal orifices were found in the pyriform sinus by direct laryngoscopy in all 71 patients under general anesthesia. Two patients had a postoperative temporary hoarseness that resolved after 3 months. The other patients had no complications such as parapharyngeal abscess and incision infection. All patients were followed up for 23 months-70 months, and no recurrence was found. The novel surgical procedure of PSF performed via the hypopharynx has advantages such as a short operation path, quick recovery, fewer complications, and a low recurrence rate. This method is a better choice for managing recurrence cases after repeated cauterization endoscopic surgeries, as well as for patients with visible cervical surgical scars or masses.

Anal Fistula in Children: A Case Report from The Donka Chu National Hospital in Conakry

Introduction: anal fistula (AF) is a common anorectal disorder, with an estimated incidence of 0.5% to 4.3% in daily practice in infants. Most cases occur in children under one year of age, with a strong male predominance. Anal fistula during these periods is probably congenital in origin. The aim of our study was to discuss a case of crypto-glandular anal fistula in children. Case Report: 4-year-old patient admitted with a purulent perianal discharge of congenital origin. He had no previous history of the condition and was the second oldest of three siblings. General examination showed a lucid patient with a good physical appearance and good colouration of the integuments and conjunctivae. Pulse = 90/min; FR=26/ min; the abdomen was symmetrical and supple with no hepatosplenomegaly. Examination of the perineum showed a cutaneous orifice in the form of a granuloma of left lateral topography. The cryptic orifice was visible with the finger prick (Good Sall). Biological tests were unremarkable. We performed a fistulectomy (Figures 2 and 3); the specimen sent to the pathology department showed a fleshy bud on the fistulous pathway. Conclusion: Crypto-glandular anal fistula in children is a common condition. It is diagnosed clinically, and surgical treatment remains appropriate in our context despite the lack of consensus.

Retrospective review of M3C-Necker three-decade experience with transcatheter management of coronary artery fistulas in children

Retrospective review of M3C-Necker three-decade experience with transcatheter management of coronary artery fistulas in children

Commentary on Endoscopic Chemocauterization with Trichloroacetic Acid for Congenital or Recurrent Tracheoesophageal Fistula in Children with Esophageal Atresia: Experience from a Tertiary Center

Commentary on Endoscopic Chemocauterization with Trichloroacetic Acid for Congenital or Recurrent Tracheoesophageal Fistula in Children with Esophageal Atresia: Experience from a Tertiary Center

Endoscopic Chemocauterization with Trichloroacetic Acid for Congenital or Recurrent Tracheoesophageal Fistula in Children with Esophageal Atresia: Experience from a Tertiary Center

BackgroundRecurrent tracheoesophageal fistula (rTEF) is a well-known complication after surgery of EA, occurring in roughly 3–10% of the patients. Recent studies have highlighted safety and efficacy of endoscopic management of recurrent TEF. The aim of this study was to evaluate the efficacy of chemocauterization with trichloroacetic acid (TCA) in rTEF and congenital tracheoesophageal fistula (cTEF). MethodsRetrospective chart review of consecutive patients with recurrent or congenital TEF who underwent endoscopic chemo-cauterization between 2018 and 2022 at a tertiary center. Children diagnosed with TEF who underwent primary or secondary endoscopic treatment were included. Median follow up time was 19 months for rTEF and 33 months for cTEF. ResultsDuring the study period, 18 patients were treated endoscopically by chemocatuerization with TCA at our institution. Treatment of recurrent TEF was successful in 13 of 14 patients (93%) Treatment of congenital TEF was successful in 2 of 4 patients (50%). In 14 patients, closure was seen after 1–2 treatments. There were no serious adverse reactions or complications to the endoscopic treatment of TEF. ConclusionEndoscopic chemocauterization is a minimal invasive technique with low morbidity and high success rate and may be considered as primary treatment for recurrent TEF. Level of evidenceIII.

Acute paraproctitis and anal fistula in children: A review

Acute paraproctitis and pararectal fistulas are common diseases in infants and adolescents. To date, discussions are ongoing about whether to use conservative or surgical treatment options, their implementation, and the use of antibiotics during the perioperative period. The study is based on a literature review of treating children with this pathology. The databases in Russian eLibrary.ru and English Medline, Web of Science, and PubMed were searched for literature sources. The following keywords were entered into the search: acute paraproctitis, pararectal fistulas, fistulotomy, and fistulectomy. There were 155 papers discovered, 51 of which were congruent with the purpose of our study and were evaluated. According to the data presented in the literature review, pararectal fistula is the outcome of acute paraproctitis in 20%85% of cases. The cause of acute paraproctitis and pararectal fistulas in children is unknown. Imaging methods that allow you to identify all the hidden passages and characterize the relationship between the fistula and the anal sphincter play an important role in diagnosing pararectal fistulas. Cellular technologies are being used as a conservative treatment with established approaches. Incision and drainage are the preferred surgical procedures in treating acute paraproctitis, and fistulotomy is used in pararectal fistulas. Stem cell therapy is described as a promising treatment. Relapses of paraproctitis and/or the establishment of pararectal fistulas occur at a rate ranging from 0% to 85%. Such a large range may be related to the nature of the treatment and how fistulas are classified as relapses or complications. The recurrence of abscesses and anal fistulas is closely related to the type of surgical intervention. If the channel of the anal fistula is not identified and not dissected, the risk of recurrence is relatively high. Based on the findings of the data analysis, it is possible to infer that there is currently no single procedure for treating children with acute paraproctitis and pararectal fistulas. This explains the importance of performing randomized prospective studies to determine the best treatment strategies for children with this pathology.

One-stage operation surgical efficacy observation of congenital preauricular fistula infection and static period of inflammation in children

Objective:To compare the clinical effect of surgical treatment of congenital preauricular fistulas in children during the local infection period and static inflammatory period. Methods:Forty children with congenital preauricular fistula infection treated in our hospital from January 2020 to December 2022 were selected as the experimental group, and 39 children with congenital preauricular fistula inflammation at static period were selected as the control group. The fistula of the two groups of children aged between 1-14 years old was located in front of the foot of the ear wheel or the foot of the ear wheel, and all were unilateral fistulas. The postoperative follow-up was 6 months to 2 years, and the efficacy of the two groups was compared. Results:There was no significant difference in the healing rate of stage Ⅰ and stage Ⅱ between the two groups（P>0.05）. There was no significant difference in fistula recurrence rate and satisfaction with the preauricular scar between the two groups after treatment（P>0.05）. There was no significant difference in postoperative hospital stay between the experimental group and the control group（P>0.05）. Conclusion:The effect of surgical treatment of congenital preauricular fistula in the infected period is similar to that of surgical treatment in the static period of inflammation, and it can reduce the pain of dressing change under local anesthesia in children, avoid the second operation in children, and reduce the economic cost. This treatment method is worthy of clinical promotion. Appropriate incision and resection method were designed according to the fistula and infection sites.

Isolated tracheo-esophageal fistula in children: Analysis of a large multicentric series and proposal of a comprehensive treatment algorithm

BackgroundIsolated tracheo-esophageal fistulas (TEF) are rare and challenging, possibly leading to severe complications. We evaluated the outcomes in a large series of patients treated in 9 referral Centers for airway surgery, and suggested an ideal management algorithm. MethodsA multicentric retrospective study on TEF was performed. Results186 cases were collected. Among 101 patients with recurrent TEF after EA repair, 1 was treated successfully with thoracoscopy, 23 with open surgery with TEF division and tissue interposition, with 15 complete resolution (65 %), 2 TEF recurrence (9 %) and 6 other complications (26 %), and 77 received TCA endoscopic cauterization, with complete resolution in 61 (79 %). Among 54 patients with congenital H-type fistula, 1 received conservative treatment with resolution; 4 underwent thoracoscopy (50 % resolution); 6 had endoscopic cauterization (33 % resolution); 44 received open surgery, with 43 (98 %) successes. In the last group, the majority of TEF was ligated and divided with tissue interposition. Among 26 post-traumatic fistulas (mechanical trauma, battery or caustic ingestion), 6 patients received endoscopic procedure and 5 of them (83 %) reached complete resolution. The other 19 received open surgery (trans-tracheal direct FTE closure with tracheal resection), and 12 had complete resolution (63 %). Two patients eventually died and complication rate was 23 %. Other 5 cases (3 Bronchial-Esophageal Fistulas and 2 TEF after cleft repair) were treated endoscopically or with open approach. ConclusionEndoscopic cauterization can be the preferred treatment for recurrent TEF after EA, while for the congenital H-type and post-traumatic TEF the open approach remains our first choice.

Anterior mediastinal tracheostomy for severe tracheal stenosis in a child with severe motor and intellectual disabilities: a case report

BackgroundOwing to recurrent aspiration pneumonia and airway stenosis secondary to thoracic deformities, tracheostomy or laryngotracheal separation are often necessary in children with severe motor and intellectual disabilities. However, these procedures are associated with the risks of tracheal stenosis due to tracheal granulation and tracheoinnominate artery fistula formation. We report a case of a child with severe motor and intellectual disabilities treated with an anterior mediastinal tracheostomy.Case presentationThe patient was a 15-year-old boy with severe motor and intellectual disabilities due to intractable epilepsy. Due to thoracic deformity and tracheomalacia, the patient had a flattened and narrowed trachea. Accordingly, laryngotracheal separation was performed 4 months before admission to avoid aspiration pneumonia. Due to a common cold, the patient required frequent sputum suctioning, which exacerbated the tracheal stenosis. Bronchoscopy revealed tracheal stenosis 4–5 cm caudal to the tracheostomy site, tracheal mucosal ulcers, and pulsation of the innominate artery on the anterior wall of the trachea. We performed an anterior mediastinum tracheostomy to release the tracheal stenosis and prevent tracheoinnominate artery fistula formation.ConclusionsAnterior mediastinal tracheostomy has several advantages. Including sufficient release of bony compression, release of tracheal hyperextension, and relief of tracheal and innominate artery contact ensures a cannula-free tracheostomy, and there is no need to dissect the brachiocephalic artery. It is the procedure of choice in cases of head and neck malignancies requiring extensive tracheal resection and could be a good surgical option for severe tracheal stenosis and tracheoinnominate artery fistula in children with severe motor and intellectual disabilities.

Diagnosis of congenital bronchobiliary fistula in children by bilirubin crystallization in the bronchoalveolar lavage fluid: A case report and literature review

Congenital Bronchobiliary Fistula (CBBF) is a rare disease with abnormal connection between the biliary tract and the bronchus.

Esophago-Vascular Fistulae in Children: Five Survivors, Literature Review, and Proposal for Management

IntroductionEsophago-vascular fistulae in children are almost uniformly fatal with death occurring by exsanguination. We present a single centre series of five surviving patients, a proposal for management and literature review. Materials and methodsPatients were identified from surgical logbooks, surgeon recollection and discharge coding data. Demographics, symptoms, co-morbidities, radiology, management and follow up details were recorded. ResultsFive patients (1M, 4F) were identified. Four were aorto-esophageal and one caroto-esophageal. Median age at initial presentation was 44 (8–177) months. Four patients had cross sectional imaging prior to surgery. Median time from presentation to combined entero-vascular surgery was 15 (0–419) days. Four patients required repair on cardio-pulmonary bypass with four undergoing staged surgical procedures. All required combined esophageal and cardio-vascular surgery.Length of PICU stay following combined surgery was 4 (2–60) days and overall hospital stay was 53 (15–84) days. Median follow up was 51 (17–61) months.Two patients had esophageal atresia and trachea-esophageal fistula managed as neonates. Three had no co-morbidities. Four had esophageal foreign bodies:1 esophageal stent, 2 button batteries, 1 chicken bone. One patient had a complication following colonic interposition. Four patients required an esophagostomy at the time of definitive surgery. All patients were alive and well at last follow up with one having successful reconnection surgery. ConclusionIn this series, outcomes were favourable. Multidisciplinary discussion and surgery are mandatory. If hemorrhage is controlled at presentation, then survival to discharge is possible but the magnitude of surgical intervention is both significant and very high risk. Level of evidenceLevel 3.

Multimodal imaging of congenital pyriform fossa fistula in children.

Our aim was to explore the clinical value of multimodal imaging examinations in the diagnosis of congenital pyriform fossa fistula in children, so as to provide clues for the early diagnosis and treatment of congenital pyriform fossa fistula. The clinical and imaging data of 55 children with pyriform fossa fistula diagnosed surgically in our hospital from 2015 to 2018 were analyzed retrospectively. All 55 patients underwent a CT scan. Of those patients, contrast enhancement CT was performed in 47 cases, MRI was performed in 2 cases, and barium esophagography was performed in 41 cases. Among the 55 cases, there were 24 male patients and 31 female patients. The age ranged from 11 months to 13 years old, and the median age was 3.8 years old. The lesions of 49 cases (89.1%) were located on the left side, and the imaging of CT showed soft tissue mass in the anterior cervical region blurred boundary. There was ipsilateral thyroid involvement in 50 cases (90.9%), trachea and/or carotid sheath extension in 43 cases (78.2%), abscess formation in 39 cases (70.9%), and pneumatosis in 25 cases (45.5%). The CT examination of 22 children after treatment showed a linear or tubular low-density shadow in the thyroid gland, gas accumulation in the anterior cervical region or thyroid, and residual contrast medium, partly. A total of 24 cases underwent barium esophagography during the acute phase, and 15 cases (62.5%) showed sinus formation from the pyriform fossa downward or punctate high-density shadow in the anterior cervical region. The 2 cases where MRI was performed showed abscess formation in one side of the neck and thyroid involvement. Pyriform fossa fistula is most common in the left anterior cervical region, and it is closely related to the thyroid gland. The plain and enhanced-contrast CT scan can be used as the first choice during the infection stage. It helps to understand the location, extent, and structure of the surrounding tissue. The preliminary diagnosis of pyriform sinus fistula was according to the imaging features. It provided an important basis for clinical diagnosis and reduced the pain caused by repeated infection or surgical incision and drainage.

A Case of Heterotopic Salivary Gland in the Neck Mimicking a Brachial Cleft Anomaly

Heterotopic salivary gland tissue (HSGT) consists of salivary tissue in places where it does not normally exist. Usually, HSGT presents as a draining sinus or nodule of the neck. The pathogenesis of HSGT of the neck remains uncertain. But HSGT in the neck is most widely thought to arise from defective closures and ectodermal hetroplasia of the precervical sinus of His. HSGT in the neck is rare and only a few cases have been reported in Korea. We recently experienced a case of HSGT in the neck presenting as a fistula of the anterior lower neck. We thought this as a 2nd brachial cleft anomaly; however, biopsy revealed HSGT. HSGT in the neck should be considered as one of the causes of a neck mass or fistula in children. Herein, we report this case of HSGT with a literature review.

Is there a role for caudal anesthesia on postoperative urethrocutaneous fistula in children undergoing hypospadias surgery?

Objective: Hypospadias is defined as incomplete closure of the penile structures during embryogenesis. Surgical correction induces various complications, including urethrocutaneous fistula (UCF). The aim of this study was to determine the risk factors for the occurrence of UCF in children undergoing hypospadias repair under caudal anesthesia. Method: The medical records of children undergoing hypospadias repair between January 2013 and July 2018 were included. Data on patients’ age, body weight, height, type of repair procedure, type of hypospadias, duration of surgery, and hospitalization, and postoperative complications were analyzed. Results: The mean age of the 122 patients was 4.8±3.7 years. The type of surgery performed was tubularized incised plate urethroplasty (Snodgrass) in 90 (73.8%) and meatal advancement and glanuloplasty (MAGPI) in 32 (26.2%) children. Sixteen (13.1%) children had postoperative complications, all of which were UCF. No statistical association was found between postoperative UCF and patient variables. The most common complication of hypospadias repair is UCF, which occurs mostly in the immediate postoperative period. Conclusion: Hypospadias repair can result in complications. UCF remains a significant problem in the postoperative period. All patients underwent caudal block and despite the previous literature, we experienced lower rates of penile engorgement and postoperative UCF. These results showed that there was no cause-and-effect relationship between the caudal block and UCF. We think that the development of a urethrocutaneous fistula is mostly related to surgical causes and well-designed, prospective, and controlled studies are required to elucidate this issue.

Effect analysis of individualized operation for congenital preauricular fistula

Objective:To investigate the effect and influencing factors of individualized operation for congenital preauricular fistula in children. Methods:The clinical data of 98 cases （109 ears） of congenital preauricular fistula treated in Department of Otolaryngology，Fuzhou Children's Hospital of Fujian Medical University from July 2016 to December 2020 were retrospectively analyzed. According to the characteristics and infection of preauricular fistula，they were divided into common type and variant type，static period of inflammation and period of infection.Individual surgical methods such as classical fistula resection, double fusiform incision and fistula location resection were used respectively.The efficacy，complication and influencing factors of different surgical methods were analyzed. Results:The operation time of classical fistula resection was shorter, and the difference was statistically significant（t = －2.905 and－3.005 respectively, all P<0.05）. According to the stages and types of fistulas, the selection of individualized surgical methods had achieved good results. There was no significant difference in incision complications and fistula recurrence among different surgical methods （all P>0.05）. Conclusion:Once infection occurs in congenital preauricular fistula, surgical resection should be performed as soon as possible after infection control, or as early as possible after infection maximum control if infection cannot completely subside. Surgical incision design should be individualized, complete resection of fistulas and lesions, minimally invasive and aesthetic.