Complications and management of thyroglossal duct cyst following Sistrunk procedure in children: a single-center retrospective study in Shanghai, China.

Abstract

Background: Thyroglossal duct cysts (TGDCs) are the most common congenital neck masses in children, and the Sistrunk procedure is the established standard surgical treatment; however, large pediatric-specific studies that systematically characterize the full spectrum of postoperative complications using standardized grading systems remain scarce. This study aimed to investigate the incidence, spectrum, and risk factors of complications following the Sistrunk procedure for TGDC excision in a pediatric population, and to summarize effective perioperative management strategies.

Methods: A retrospective analysis was conducted on all pediatric patients with TGDC who underwent Sistrunk surgery at Shanghai Children's Hospital (Shanghai, China), a tertiary academic pediatric referral center affiliated with Shanghai Jiao Tong University School of Medicine, between January 2019 and December 2023. Surgical complications were graded according to the Clavien-Dindo classification. Risk factors for postoperative recurrence were analyzed using Chi-squared or Fisher's exact tests as appropriate. Variables included age, sex, prior recurrence status, preoperative infection history, and perioperative antibiotic use. Statistical analyses were performed using SPSS version 22.0, with significance set at P<0.05.

Results: A total of 170 children (89 males, 81 females; mean age 4.72 years; mean follow-up 3.1 years) were included. Twenty-seven patients (15.9%) had undergone prior surgery at other institutions. Overall, 56 patients (32.9%) experienced at least one postoperative complication. By Clavien-Dindo grade, the distribution was as follows: Grade I, 19 patients (11.2%); Grade II, 10 patients (5.9%); Grade III, 11 patients (6.5%). Specific complications included fever (8.8%), salivary amylase-rich seroma (7.1%), wound infection (4.7%), TGDC recurrence (4.7%), pharyngeal leakage (1.2%), and postoperative bleeding requiring reoperation (1.2%). Notably, 12 patients (7.1%) developed seroma with salivary amylase-rich fluid, a previously under-recognized complication. Preoperative TGDC infection was the only significant predictor of recurrence on univariate analysis (13.7% vs. 0.8%, P<0.001). Age, sex, prior recurrence, and perioperative antibiotic use showed no significant association with recurrence.

Conclusions: The Sistrunk procedure is the standard surgical approach for pediatric TGDC; approximately one-third of patients experienced complications, most of which were minor. Preoperative TGDC infection is a strong predictor of recurrence. Recognition of salivary amylase-rich seroma as a distinct complication and implementation of targeted perioperative care-including dietary modification, wound compression, and vigilant monitoring for airway compromise-are essential for optimizing outcomes.