Technique and efficacy of sialendoscopy in the management of recurrent sialadenitis: the Melbourne experience

Background: The purpose of sialendoscopy is to provide a minimally invasive endoscopic diagnostic and therapeutic intervention as a gland-sparing option to an otherwise open salivary surgical therapy. This paper seeks to review the safety and efficacy of sialendoscopy in the management of salivary gland disease and subsequently outlines the surgical technique for endoscopic evaluation and treatment of recurrent sialadenitis. Methods: This is a retrospective case series of sialendoscopy and sialendoscopy-assisted procedures performed in the only Victorian centre for sialendoscopy. Demographic data of all adult patients who underwent sialendoscopy between January 2015 and January 2022 at St Vincent’s Hospital, Melbourne were obtained. Electronic charts were reviewed for preoperative, intraoperative and follow up measures. Data regarding indications, technique, complication and outcomes were collected. Results: There were 80 eligible sialendoscopic procedures performed on 75 patients including 55 parotid and 25 submandibular glands. The most common indication was sialolithiasis 54/80 (67.5%), followed by stricture 30/80 (37.5%). Sialendoscopy was used as an adjunct to open techniques in two cases. Transient complications occurred in 13/80 (16.3%) procedures, most commonly creation of a false passage 9/80 (11.3%), all with spontaneous resolution. Mean operative time was 49 minutes. In the 54 patients with radiological evidence of sialolithiasis, 38 (70.4%) were located intraoperatively, and 24 (63.2%) of these had stones successfully retrieved. Just 50/75 patients attended follow up with a mean of 17.2 months. At conclusion of follow up, 21/50 (42%) patients had complete resolution of symptoms and 39/50 (78%) had improved symptoms. Conclusions: The institutional experience of St Vincent’s Hospital, Melbourne over the first 7 years of sialendoscopy would suggest that sialendoscopy is a safe and efficacious procedure in the first instance for stones, strictures, and recurrent sialadenitis. It does not make open surgery obsolete but provides a safe, minimally invasive, gland-preserving alternative for many patients.