Individualized surgical treatment for congenital pyriform sinus fistula in children: a retrospective analysis of 50 cases

Objective To evaluate the outcomes of individualized surgical treatment for congenital pyriform sinus fistula (CPSF) in children according to clinical type. Methods Clinical data from 50 children with CPSF admitted between July 2015 and May 2025 were retrospectively analyzed. Patients were classified into three groups according to clinical presentation: neonatal cystic type (Group A, n = 5), treated with open excision of the sinus tract; noninfected type (Group B, n = 15), treated with low-temperature plasma radiofrequency ablation under suspension laryngoscopy; and acute infection type (Group C, n = 30), treated with one-stage plasma ablation combined with neck abscess incision and drainage. Operative time, length of hospital stay, complications, and recurrence rates were compared among the groups. Results All 50 procedures were completed as planned, with no conversion to open surgery in Groups B or C. Operative time and length of hospital stay differed significantly among the three groups ( P < 0.001 and P = 0.012, respectively). Postoperative fever occurred in 0/5 patients in Group A, 1/15 (6.7%) in Group B, and 11/30 (36.7%) in Group C ( P = 0.024). Transient vocal cord paresis(hoarseness) occurred in 7/50 patients (14.0%). At the 3-month clinical follow-up, all 50 patients met the cure criteria (50/50). During the observation period (median, 42 months; IQR, 19–60), 1 of 50 patients (2.0%; 95% CI, 0.05–10.6) developed recurrence at 16 months postoperatively, while the remaining 49 patients (98.0%; 95% CI, 89.4–99.9) remained recurrence-free. Given that routine clinical follow-up was limited to 3 months in asymptomatic patients, the long-term recurrence rate may be underestimated. Conclusion In this retrospective, single-center study, individualized surgical treatment tailored to clinical type was associated with favorable outcomes at 3 months in children with CPSF. However, one recurrence occurred during the observation period, and longer follow-up is needed to determine the long-term recurrence rate. Given the retrospective design and small sample size, these findings should be considered exploratory.