Endoscopic-Assisted Surgery for Pyriform Sinus Fistula in Chinese Children: A 73-Consecutive-Case Study

Abstract

Objective: Complete resection of the pyriform sinus fistula (PSF) tract is challenging due to repeated infection and inadequate procedures. We present our experiences with intraoperative endoscopic-assisted intubation or instillation of dye through the internal opening as a guide to identify the tract.

Materials and methods: We retrospectively reviewed the charts of 73 consecutive patients diagnosed with PSF during 1999 until 2014 from two tertiary referral centers. Demographics, clinical presentation, imaging, treatment, and outcome were analyzed.

Results: The intraoperative endoscopy was successfully conducted in all 73 cases. No gender predominance was observed. Of the anomalies, 94.5% were left-sided. Presenting symptoms consisted of neck abscess (n = 48), acute suppurative thyroiditis/thyroid abscess (n = 9), neck mass with or without dyspnea (n = 12), and thyroid nodule (n = 4). Barium esophagography and computed tomography scan with oral or intravenous contrast had a satisfactory positive predictive value. Partial thyroidectomy was performed on 25 cases (34.2%) if the ipsilateral thyroid was involved. Good outcome was achieved in all but 3 patients (70/73, 95.9%) during a median follow-up of 4 years (range, 8 months-14 years). Two patients developed postoperative complications: temporary vocal fold motion impairment and left-sided Horner's syndrome, respectively. PSF recurred in 1 case.

Conclusions: A complete resection is essential for good outcomes. Intraoperative intubation or methylene blue injection by endoscopy can simplify the identification of the fistula tract during surgical exploration.