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

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.

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.

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.

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.