Objective: To compare the efficacy, advantages and disadvantages of endoscopic
CO2 laser cauterization (ECLC) and open neck surgery in the treatment of congenital pyriform sinus
fistula (CPSF). Methods: From September 2014 to March 2017, 80 cases with confirmed diagnosis of CPSF received initial treatment at Guangdong Provincial People's Hospital were prospectively analyzed, including 34 males and 46 females, aged 18 to 672 (194.17±141.18) months. They were consecutively divided into endoscopic group and open-surgery group, with 40 cases in each group. Both groups of patients received surgical treatment under
general anesthesia. The endoscopic group was treated by endoscopic
CO2 laser cauterization, and the open-surgery group underwent the following surgery: first, we performed
suspension laryngoscopy examination to confirm the presence of
fistula in the bottom of the piriform fossa, then open-neck resection of congenital piriform sinus
fistula with recurrent laryngeal nerve and/or lateral branch of superior laryngeal nerve anatomy plus partial
thyroidectomy were performed. The data between the two groups were compared, including the
operative time, intraoperative
blood loss, postoperative pain, average
length of stay, neck cosmetic scores, complications and cure rates. All patients were followed up in outpatient clinics. Statistical analysis was performed using SPSS 20.0 software. P<0.05 indicates that the difference is statistically significant. Results: All patients were successfully completed the operation. The
operative time, intraoperative
blood loss, postoperative pain and average length of
hospital stay in the endoscopic group were significantly less than those in the open group [(27.4±5.5) min to (105.8±52.5) min, (0.6±0.5) ml to (33.6±41.5) ml, (1.7±0.9) points to (4.6±0.7) points, (5.9±2.9)d to(8.9±3.3)d, t values were-9.400, -5.031, -16.199, -4.293, P values were all<0.01]; The neck cosmetic score in the endoscopy group was significantly greater than that of the open group [(9.9±0.4) against (5.8±0.9) points, t=25.847, P<0.01]. Compared with the open group (15.0%, 6/40), the complication rate of the endoscopic group (7.5%, 3/40) was not statistically significant (χ²=0.50, P>0.05). Three months after the first treatment, the cure rate in the endoscopic group (82.5%, 33/40) was significantly lower than that in the open-neck group (100.0%, 40/40), χ²=5.64, P<0.05. The follow-up time was 12 months after the last treatment. Eighty cases were followed up and none was lost to follow-up. During the follow-up period, the cure rate of the endoscopy group (97.5%, 39/40) was compared with that of the open group (100.0%, 40/40), and the difference was not statistically significant. Conclusions: In the treatment of CPSF, the two-surgical method each has their advantages. Compared with open-neck surgery, ECLC is simpler, repeatable. ECLC has shorter time in operation and
hospital stay, less complications, and less
postoperative pain and more precise cosmetic results. It could be preferred for the initial treatment of CPSF and relapsed cases after
cauterization. But subject to relatively low cure rate of one-time
cauterization and uncertain long-term efficacy, it cannot completely replace the open-neck surgery at present.