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Endoscopic-assisted surgery for pyriform sinus fistula in children: experience of 165 cases from a single institution.
J Pediatr Surg. 2014 Apr; 49(4):618-21.JP

Abstract

BACKGROUND

Congenital pyriform sinus fistula (PSF) is relatively rare, but often presents diagnostic and therapeutic challenges. Herein, we report our experience of endoscopic-assisted surgery of PSF in children.

METHODS

Since 1999, 165 children (100 males, 65 females) with PSF had been enrolled. Their clinical manifestations were recurrent lateral neck infection, cervical mass and respiratory distress. Preoperative investigations included barium swallow, ultrasound, computed tomography, and thyroid scan. After resolution of the infection, the fistulas were identified by the endoscopic-assisted technique at operation. The fistula tract was completely excised just at the apex of the pyriform sinus. More recently, the anatomic point where the fistula tract penetrated into the pharynx was specified and recorded.

RESULTS

Of the 165 cases, the male to female ratio was 1.54:1, the median age of onset was 3.2 years (range, 1 day to 13.8 years), and median age at operation was 5.0 years (range, 17 days to 15.0 years). One hundred fifty-six (94.6%) fistulas located on the left side, 7 right, and 2 bilateral. Twelve neonates and young infants (younger than 3 months) presented with a large cervical cyst. The fistulas were completely excised in all but 2 (98.8%) with intraoperative gastroscopy successfully conducted in 160 cases (97.0%). In 77 cases the points where fistulas penetrated into the pharynx were specified intraoperatively, which were classified into 3 types according to their anatomic relationship with the inferior cornu of the thyroid cartilage (ICTC): type I (anterior to ICTC), 22 cases (28.5%); type II (inferior to ICTC), 18 cases (23.4%); and type III (posterior to ICTC), 37 cases (48.1%). Postoperatively, 160 cases recovered well without complications. PSF recurred in 5 cases, 2 of whom were cured by fistula re-excision and 3 remained asymptomatic. Esophageal perforation was found and repaired uneventfully in 1 neonate and 1 young infant. Transient postoperative hoarseness happened in 1 neonate. All the latter 3 cases had cervical cysts.

CONCLUSIONS

To our knowledge, this series is the largest report of PSF in children. Our results suggested that PSF is more common in males. With the help of endoscopy and a better understanding of the anatomic relationship between ICTC and the points where the fistulas penetrated into the pharynx, PSF excision can be done successfully with minimized complications. For neonates and young infants with a cervical cyst, however, the management of PSF continues to be a challenge.

Authors+Show Affiliations

Department of Surgery of Children's Hospital, Fudan University, Shanghai, People's Republic of China. Electronic address: xmxiao@shmu.edu.cn.Department of Surgery of Children's Hospital, Fudan University, Shanghai, People's Republic of China.Department of Surgery of Children's Hospital, Fudan University, Shanghai, People's Republic of China.Department of Surgery of Children's Hospital, Fudan University, Shanghai, People's Republic of China.Department of Surgery of Children's Hospital, Fudan University, Shanghai, People's Republic of China.Department of Surgery of Children's Hospital, Fudan University, Shanghai, People's Republic of China.Department of Surgery of Children's Hospital, Fudan University, Shanghai, People's Republic of China.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24726124

Citation

Xiao, Xianmin, et al. "Endoscopic-assisted Surgery for Pyriform Sinus Fistula in Children: Experience of 165 Cases From a Single Institution." Journal of Pediatric Surgery, vol. 49, no. 4, 2014, pp. 618-21.
Xiao X, Zheng S, Zheng J, et al. Endoscopic-assisted surgery for pyriform sinus fistula in children: experience of 165 cases from a single institution. J Pediatr Surg. 2014;49(4):618-21.
Xiao, X., Zheng, S., Zheng, J., Zhu, L., Dong, K., Shen, C., & Li, K. (2014). Endoscopic-assisted surgery for pyriform sinus fistula in children: experience of 165 cases from a single institution. Journal of Pediatric Surgery, 49(4), 618-21. https://doi.org/10.1016/j.jpedsurg.2013.11.004
Xiao X, et al. Endoscopic-assisted Surgery for Pyriform Sinus Fistula in Children: Experience of 165 Cases From a Single Institution. J Pediatr Surg. 2014;49(4):618-21. PubMed PMID: 24726124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic-assisted surgery for pyriform sinus fistula in children: experience of 165 cases from a single institution. AU - Xiao,Xianmin, AU - Zheng,Shan, AU - Zheng,Jicui, AU - Zhu,Linlin, AU - Dong,Kuiran, AU - Shen,Chun, AU - Li,Kai, Y1 - 2013/11/09/ PY - 2013/09/17/received PY - 2013/10/10/revised PY - 2013/11/03/accepted PY - 2014/4/15/entrez PY - 2014/4/15/pubmed PY - 2014/12/20/medline KW - Branchial remnant KW - Children KW - Endoscopic-assisted surgery KW - Pyriform sinus fistula SP - 618 EP - 21 JF - Journal of pediatric surgery JO - J. Pediatr. Surg. VL - 49 IS - 4 N2 - BACKGROUND: Congenital pyriform sinus fistula (PSF) is relatively rare, but often presents diagnostic and therapeutic challenges. Herein, we report our experience of endoscopic-assisted surgery of PSF in children. METHODS: Since 1999, 165 children (100 males, 65 females) with PSF had been enrolled. Their clinical manifestations were recurrent lateral neck infection, cervical mass and respiratory distress. Preoperative investigations included barium swallow, ultrasound, computed tomography, and thyroid scan. After resolution of the infection, the fistulas were identified by the endoscopic-assisted technique at operation. The fistula tract was completely excised just at the apex of the pyriform sinus. More recently, the anatomic point where the fistula tract penetrated into the pharynx was specified and recorded. RESULTS: Of the 165 cases, the male to female ratio was 1.54:1, the median age of onset was 3.2 years (range, 1 day to 13.8 years), and median age at operation was 5.0 years (range, 17 days to 15.0 years). One hundred fifty-six (94.6%) fistulas located on the left side, 7 right, and 2 bilateral. Twelve neonates and young infants (younger than 3 months) presented with a large cervical cyst. The fistulas were completely excised in all but 2 (98.8%) with intraoperative gastroscopy successfully conducted in 160 cases (97.0%). In 77 cases the points where fistulas penetrated into the pharynx were specified intraoperatively, which were classified into 3 types according to their anatomic relationship with the inferior cornu of the thyroid cartilage (ICTC): type I (anterior to ICTC), 22 cases (28.5%); type II (inferior to ICTC), 18 cases (23.4%); and type III (posterior to ICTC), 37 cases (48.1%). Postoperatively, 160 cases recovered well without complications. PSF recurred in 5 cases, 2 of whom were cured by fistula re-excision and 3 remained asymptomatic. Esophageal perforation was found and repaired uneventfully in 1 neonate and 1 young infant. Transient postoperative hoarseness happened in 1 neonate. All the latter 3 cases had cervical cysts. CONCLUSIONS: To our knowledge, this series is the largest report of PSF in children. Our results suggested that PSF is more common in males. With the help of endoscopy and a better understanding of the anatomic relationship between ICTC and the points where the fistulas penetrated into the pharynx, PSF excision can be done successfully with minimized complications. For neonates and young infants with a cervical cyst, however, the management of PSF continues to be a challenge. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/24726124/Endoscopic_assisted_surgery_for_pyriform_sinus_fistula_in_children:_experience_of_165_cases_from_a_single_institution_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(13)00859-2 DB - PRIME DP - Unbound Medicine ER -