Evaluation of endoscopic coblation treatment for obliteration of congenital pyriform sinus fistula

Abstract

Background: Congenital pyriform sinus fistula is a very rare branchial apparatus malformation. Conventional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. The aim of this study was to provide an innovative endoscopic coblation technique for patients with pyriform sinus fistula and evaluate its intermediate-term effectiveness.

Methods: Retrospective case series with 112 patients (age range 3–36 years) between 2013 and 2016 and underwent endoscopic coblation of the sinus fistula. Data collected including patient demographics, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospital stay, and recurrence were analyzed.

Results: Of the 112 cases, there were no postoperative complications observed except temporary reddish swelling in three patients. Four cases were lost to follow-up. Of 108 patients, 106 experienced no recurrence after their first endoscopic coblation of the sinus tract. The remaining two patients with recurrence in the follow-up were ultimately treated with recoblation without complications or further recurrences. Also, Endoscopic coblation can be used to treat seven patients with recurrence who had experienced open resection. In our series, median follow-up period was 1.5 years.

Conclusion: Endoscopic coblation is an effective approach for most patients. We advocate using this minimally invasive technique as first line of treatment for pyriform sinus fistula.

Chinese abstract

背景：先天性梨状窦瘘是一种非常罕见的腮下器官畸形。常规瘘管切除手术可能无法根除病灶, 会导致持续复发。本研究的目的是为梨状窦瘘患者提供一种有创意的内镜低温消融技术, 并评估其中期疗效。

方法：回顾性分析2013年至2016年间112例（年龄3〜36岁）接受鼻内镜下鼻窦瘘低温消融治疗的患者。分析收集的数据, 包括患者人口统计学、呈现症状、诊断方法、治疗前后、住院时长和复发。

结果：112例患者除3例临时性红肿外, 未见并发症发生。4例失去随访。在108例患者中, 106例患者在首次鼻窦内镜低温消融手术后没有复发。其余两例随访复发的患者接受了根治性二次治疗, 无并发症或复发。此外, 内镜低温消融术可用于治疗7例接受打开切除的复发患者。在我们的系列中, 中位随访时间为1.5年。

结论：对于大多数患者, 内镜低温消融术是一种有效的方法。我们主张使用这种微创技术作为梨状窦瘘的首选治疗方法。

Keywords:

• Congenital pyriform sinus fistula
• endoscopic technique
• coblation
• branchial fistula

Acknowledgements

This retrospective study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. The consent has been received from the adults and the parents of the adolescence featured in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.