Minimally Invasive Endoscopic Resection and Suture Ligation for Third Branchial Cleft Fistulas: Low Recurrence and Reduced Trauma.

Abstract

Objective: To evaluate three surgical procedures for the treatment of third branchial cleft fistulas, focusing on recurrence rates and postoperative complications.

Study design: A retrospective review of medical records was conducted for patients treated for third branchial cleft fistulas at the Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital of Chongqing Medical University, from January 2014 to October 2024.

Setting: Tertiary care hospital.

Methods: Patient demographics, clinical presentations, surgical details, complications, outcomes, and follow-up data were collected and analyzed.

Results: The cohort consisted of 14 males and 15 females with a median age of 27 years. The left neck was affected in 82.76% of cases. The most frequent symptoms were neck swelling (89.66%) and pain (77.78%). No postoperative complications, particularly pharyngocutaneous fistulas or vocal cord paralysis, occurred. Overall, seven patients in our cohort had an internal fistula located in the piriform fossa found under preoperative fibrolaryngoscopy. Recurrence was observed in 17.6% of patients who underwent open surgery alone during a follow-up period ranging from 37 to 120 months, while no recurrence was noted in patients who had additional endoscopic resection plus suture ligation or endoscopic resection plus suture ligation alone. The three procedures showed significant differences in the operation time, blood loss, and postoperative hospital stay.

Conclusion: The endoscopic resection plus suture ligation approach demonstrated a low recurrence rate and offered aesthetic and minimally invasive advantages in this study.