Thulium fiber laser cauterization approach to congenital pyriform sinus fistula: a case series

Congenital pyriform sinus fistula (CPSF) commonly induces recurrent cervical infection and suppurative thyroiditis in children. Endoscopic minimally invasive approaches have been widely adopted to replace invasive open surgery. Nevertheless, clinical data on thulium laser for pediatric CPSF remains limited, with its advantages and technical drawbacks poorly elucidated. This study aimed to evaluate the clinical efficacy of thulium laser cauterization for pediatric CPSF to enrich relevant clinical evidence.

This retrospective study enrolled 9 pediatric CPSF patients who received endoscopic thulium laser cauterization. The mean operative age was 6.46 years, and most fistulas were left-sided (8/9). Seven patients suffered from recurrent cervical inflammation or acute suppurative thyroiditis, and two had cervical abscesses. Two acute-phase patients underwent synchronous abscess drainage. The mean operative time was 14.45±7.09 minutes with negligible bleeding. Only two children developed transient low-grade fever; no severe complications occurred. The average mucosal healing time was 8.22 days. During a mean follow-up of 11.42 months, merely one case relapsed and received open surgery.

In this preliminary, single-center series of nine pediatric patients, endoscopic thulium laser cauterization appeared technically feasible and no severe complications. However, given the small sample size, retrospective design, and limited follow-up, these findings should be regarded as early clinical experience. Definitive conclusions regarding long-term efficacy and recurrence risk require larger, prospective studies with extended follow-up.