Long-term outcomes of CO2 laser cauterization for 238 children congenital pyriform sinus fistula

Abstract Objective To evaluate the efficacy and safety of single CO2 laser cauterization management for children CPSF, we collected patients underwent CO2 laser cauterization for internal fistula and accessed the long-term outcomes.Methods: Retrospective and single-center study was conducted. Microlaryngoscopy management of CO2 laser cauterization was implemented to children with CPSF to the end point as internal fistula completely closed through one or several procedures. After the standard therapeutic strategy, all patients received return visits at regular interval. Here we tested and summarized the predicting factors for effect modification and the medium and long-term outcomes. Results: We totally enrolled 238 patients cured by once or several operations of CO2 laser cauterization, with 149 (62.6%) needed one operation. The median follow-up time was 3.45 ± 1.37 years (ranging from 1.04 to 6.38 years). There were only 3 (1.26%) patients got relapse of neck infection. Throughout, none patients suffered permanent complications. We also found that the age at the first operation of CO2 laser cauterization was proved to be an independent risk factor associated with the operation frequency, in contrast to the previous therapeutic measures such as open neck surgery or incision and drainage. Conclusions: Our study found that the therapeutic strategy of CO2 laser cauterization for children CPSF showed low recurrence rate and few complications. Additionally, it suggested that the CO2 laser cauterization could be implemented to children once diagnosis confirmed without age limit. These confirm that the single CO2 laser cauterization can be a preferred first-line treatment option for children CPSF.Level of Evidence: Ⅲ