Minimally Invasive Surgery For Congenital Pyriform Sinus Fistula Based On Anatomical Analysis

Objective: To investigate the anatomical characteristics of congenital piriform sinus fistula in children and to design a minimally invasive surgical method.Methods: From July 2012 to July 2018,54 cases with CPSF were divided into two groups.Traditional group were thyroid or external fistula plane approach in 34 patients,while modified group were inferior horn of thyroid cartilage approach in 20 patients.The anatomical chamcteristics about CPSF was then studied,The following data were compared between 2 groups:incision length,operation time,intraoperative blood loss,hospital stay,the rate of radical operation,complication and postoperative recurrence were analyzed.Results: Fistula is divided into infundibular and transitional parts.Infundibular traversed behind or on the side of the posterioinferior cornu.Fistula has three types:with terminal at the upper pole of the thyroid,or reaching the skin via the thyroid or reaching the skin directly.The operative time,intraoperative bleeding,incision length,hospital stay and recurrence rate in the modified group were lower than those in the traditional group(p< 0.01).After 6-18 months follow-up,the recurrence rate was 29.4% in the traditional group,but no recurrence was found in the modified group.Conclusion: Piriform fossa fistulectomy was performed through posterioinferior cornu with advantages such as short operation path,quick recovery,and low recrudescence rate.It was a better choice in management of PSF owing to its safe and effective.