Reoperation for Pyriform Sinus Fistula in Pediatric Patients

Abstract

Introduction: The aim of this study was to analyze the authors' experience in re-operative surgery for children with pyriform sinus fistula (PSF) who were subjected to attempted but failed operations. Methods: We retrospectively analyzed the medical records of 30 patients with PSF who underwent reoperation (i.e., a revision of the primary performed definitive procedure) from January 2010 to December 2018. Results: There were 19 boys and 11 girls. Twenty-nine cases were left-sided. The median age of the patients when they underwent the primary operation was 5.5 years (range, 15 days-14 years). Five children received two definitive procedures from outside hospitals. The primary operations included traditional open-neck surgery (n = 30), endoscopic-assisted open-neck surgery (n = 4), and endoscopic laser cauterization (n = 1). The median time from primary operation to recurrence was 4 months (range, 1 month-4 years). The reasons for recurrence were incomplete resolution of infection (n = 7), incomplete resection of the fistula (n = 23), cauterization of PSF inner orifice (n = 1), only cyst excision in neonates (n = 2), and unknown (n = 2). All 30 children underwent endoscopy-assisted open-neck surgery. The median age of the children when they underwent reoperation was 8 years (range, 2-17 years). The fistula was detected in 29 cases (96.7%). After reoperation, good outcome was achieved in 27 patients (90%). Wound infection developed in one case. PSF recurred in two cases (6.7%). Conclusion: Most of the recurrences observed by us are preventable. Complete resolution of infection, clear verification, and exact resection of the fistula at a high level are essential for preventing recurrence. Endoscopy-assisted surgery is effective for PSF reoperation.

Keywords: children; endoscopy; pyriform sinus fistula; recurrence; reoperation.

Figure 1

(A) Neck abscess formed 2 years after the primary operation in an 11-years-old boy (written informed consent was obtained from the patient and his parent for the publication of this image). (B) CT axial scan showed abscess in the left side of the neck.

Figure 2

Barium esophagography (A) and CT coronal scan (B) showed pyriform sinus fistula in non-infected state (arrow, the same patient in Figure 1).

Figure 3

CT coronal scan showed air density before primary operation (A, arrow) and reoperation (B, arrow).

Figure 4

Operative view of the remaining fistula tract (arrow).