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Spinelli C, Ghionzoli M, Ugolini C, Oreglio C, Guglielmo C, Morabito A, Patrizio A, Fallahi P, Ferrari SM, Antonelli A. Does thyroglossal duct arborization play a role in the post-surgical outcome of Sistrunk procedure in children? Eur Arch Otorhinolaryngol 2024; 281:3791-3796. [PMID: 38594507 PMCID: PMC11211129 DOI: 10.1007/s00405-024-08631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The purpose of the present study is to analyze thyroglossal duct cyst (TGDC) histopathological features, with focus on "arborization", in a cohort of pediatric patients who underwent surgical removal, and evaluate a possible correlation with clinical recurrences. METHODS A retrospective analysis of all patients who underwent surgical resection for TGDC at the division of Pediatric Surgery of the University of Pisa from 2015 to 2020 was performed; for each patient, the following data were recorded: age, sex, clinical presentation, localization, size of the lesion, diagnostic tools, histopathological features, perioperative complications, recurrence and follow-up. RESULTS With respect to arborization, following histopathological analysis 25/30 patients (83.3%) presented thyroglossal duct branching. After a median follow-up of 3.5 years, only 2 out of 30 patients (6.7%), one male and one female, respectively aged 4 y.o. and 6 y.o., presented recurrence within one year from first surgery. CONCLUSION Surgery for TGDC remains a challenge for pediatric surgeons, while arborization was present in most of our cases which underwent surgery. With respect to the role of arborization, our study did not highlight sufficient conclusive data regarding their role in recurrence: instead, it showed wide resection as satisfactory, being the arborization present in most of the cases at histopathology.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia
| | - Chiara Oreglio
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Carla Guglielmo
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia.
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Wynings EM, Wang CS, Parsa S, Johnson RF, Liu CC. Risk-adjusted analysis of perioperative outcomes after the Sistrunk procedure. Laryngoscope Investig Otolaryngol 2023; 8:1571-1578. [PMID: 38130263 PMCID: PMC10731482 DOI: 10.1002/lio2.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/22/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Thyroglossal duct cyst (TGDC) is the most common pediatric congenital neck mass. The Sistrunk procedure is the standard method of excision and is associated with low rates of recurrence. This study aimed to review our institution's outcomes following the Sistrunk procedure, specifically the rates of wound complications and cyst recurrence. Methods This was a retrospective case series of pediatric patients undergoing the Sistrunk procedure from June 2009 to April 2021. Results A total of 273 patients were included. Of these, 139 (53%) patients were male and 181 (66%) were white. The average age at the time of surgery was 7.1 years. The overall cyst recurrence rate was 11%. The most common wound complications were seroma (14%) and surgical site infections (SSIs) (12%). Wound complications were associated with prior history of cyst infection (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.07-3.60, z-test 2.2, p = .03). Pediatric surgery was associated with fewer wound complications (OR 0.18; 95% CI 0.05-0.6, z-test -2.78, p = .005). However, pediatric surgery operated on fewer patients with a history of cyst infection (36% vs. 55%, p = .012). Drain placement and postoperative antibiotics did not affect rates of wound complications. Conclusions Prior cyst infection is associated with increased rates of postoperative wound complications. Postoperative antibiotics and drain placement did not significantly affect complication rates. Level of Evidence 4.
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Affiliation(s)
- Erin M. Wynings
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Cynthia S. Wang
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Shyon Parsa
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Romaine F. Johnson
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Division of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Christopher C. Liu
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Division of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
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Pool C, Rosi-Schumacher M, Ehret C, King TS, Wilson MN. Outpatient Sistrunk procedure: A retrospective analysis. Int J Pediatr Otorhinolaryngol 2020; 139:110455. [PMID: 33157457 DOI: 10.1016/j.ijporl.2020.110455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/22/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The risk of expansile hematoma and airway compromise following neck surgery have been used to validate overnight observation. We investigated the outcomes of pediatric patients undergoing a Sistrunk procedure via either same day surgery or overnight observation. METHODS A retrospective review of patients undergoing Sistrunk procedures between January 1, 2008 to January 1, 2019 was performed. 76 cases were identified for review. Bivariate and multivariable analyses were performed to determine predictive factors for overnight admission as well as associations between overnight observation and adverse outcomes (hematoma, seroma, airway compromise, infection). Factors evaluated for analysis included ASA class, surgeon type, history of pre-operative infection, recurrent case, operation >90 min, pharyngeal violation, intraoperative cyst rupture, cyst size, and drain placement. RESULTS No patients had life-threatening adverse events. There was no difference in complication rates between same day discharge (17%) and overnight observation (23%, p = 0.47). Otolaryngologists were more likely to admit patients overnight (88% vs. 14%, p = 0.042) as well as place a drain (97% vs. 24%, p < 0.001) when compared to pediatric surgeons. Drain placement was associated with overnight observation (73% vs. 3%, p < 0.001). Multivariable logistic regression demonstrated drain placement (OR 21.9, 95%CI (2.5-189.7), p = 0.005) and otolaryngologist as operative surgeon (OR 11.7, 95%CI (2.8-48.2), p < 0.001) as strong predictive variables for overnight observation. There was no association between other investigated variables and adverse events or overnight stay. CONCLUSION Same day Sistrunk operations are safe in select healthy patients. Overnight observation appears to be driven by drain placement and surgeon practice patterns.
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Affiliation(s)
- Christopher Pool
- Penn State Hershey Medical Center, Department of Otolaryngology - Head and Neck Surgery, USA
| | | | | | | | - Meghan N Wilson
- Penn State Hershey Medical Center, Department of Otolaryngology - Head and Neck Surgery, USA.
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Cheng J, Lerebours R, Lee HJ. Current trends and 30-day surgical outcomes for thyroglossal duct cyst excision in children. Int J Pediatr Otorhinolaryngol 2020; 128:109725. [PMID: 31644997 PMCID: PMC6934095 DOI: 10.1016/j.ijporl.2019.109725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/11/2019] [Accepted: 10/10/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Identify current trends, adverse events, and clinical predictors in children treated with thyroglossal duct cyst surgery. METHODS Cross-sectional analysis using American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012-2016. Patients were identified using CPT codes: 60280 - excision of thyroglossal duct cyst or sinus and 60281 - excision of thyroglossal duct cyst or sinus, recurrent. RESULTS 1532 (333 inpatient and 1199 outpatient) total cases were identified. Median age was 5.16 years interquartile range [IQR] (2.87, 8.35 years). No mortalities, cases of sepsis or nerve injury were identified. Adverse event rate was 4.4% (68/1532). Inpatient cases were associated with higher rates of adverse events (p = 0.006). Adverse events mostly consistent of wound infections, unplanned reoperations and readmissions, 2.6%, 2.2% and 2.0%, respectively. The most common unplanned reoperation was hematoma, seroma, or fluid drainage (0.59%). Median length of stay was 1 day, IQR (0, 1). An adjusted, multivariable logistic regression model revealed that the odds of adverse event rates for inpatient status were 101% higher than outpatients (odd ratio [OR] = 2.01; 95% CI = 1.20, 3.37; p = 0.008). CONCLUSIONS The most common adverse events were unplanned reoperations and readmissions. Outpatient surgery was most common and surgery for recurrent thyroglossal duct cysts was rare. Children selected for outpatient thyroglossal duct cyst surgery tended to be healthier and less medically complicated and may contribute to our observation of lower rates of adverse events compared to inpatients.
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Affiliation(s)
- Jeffrey Cheng
- Pediatric Otolaryngology, Department of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Reginald Lerebours
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
| | - Hui-Jie Lee
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
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de Luca U, Mangia G, Tesoro S, Martino A, Sammartino M, Calisti A. Guidelines on pediatric day surgery of the Italian Societies of Pediatric Surgery (SICP) and Pediatric Anesthesiology (SARNePI). Ital J Pediatr 2018. [PMID: 29530049 PMCID: PMC5848546 DOI: 10.1186/s13052-018-0473-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The Italian Society of Pediatric Surgery (SICP) together with The Italian Society of Pediatric Anesthesia (SARNePI) through a systematic analysis of the scientific literature, followed by a consensus conference held in Perugia on 2015, have produced some evidence based guidelines on the feasibility of day surgery in relation to different pediatric surgical procedures. The main aspects of the pre-operative assessment, appropriacy of operations and discharge are reported.
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Affiliation(s)
- Ugo de Luca
- Day Surgery Unit, Santobono-Pausilipon Pediatric Hospital, Napoli, Italy.
| | - Giovanni Mangia
- Department of Anesthesiology, San Camillo Forlanini Hospital, Roma, Italy
| | - Simonetta Tesoro
- Department of Anesthesiology, Perugia University, Perugia, Italy
| | | | - Maria Sammartino
- Department of Anesthesiology, Policlinico A. Gemelli, Roma, Italy
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Five-years' experience with outpatient thyroglossal duct cyst surgery. Int J Pediatr Otorhinolaryngol 2017; 96:65-67. [PMID: 28390616 DOI: 10.1016/j.ijporl.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Many pediatric surgeons feel uncomfortable doing Sistrunk procedure without drain placement and in an outpatient setting. This study aimed to review our pediatric surgery department's experience in managing thyroglossal duct cyst surgery and to prove feasibility and safety of Sistrunk procedure without drain placement in an outpatient setting. METHODS A retrospective review was performed of all patients who underwent Sistrunk procedure, between January 2011 and December 2015, in our department. RESULTS A total of 36 patients were included, with age ranging from 1 to 14 years (mean 6.3 years). Sixteen patients underwent day surgery, and 20 stayed overnight (with less than 24 h postoperative discharge). The main reason to stay overnight was distance (greater than 60 km or 1 h driving) between the hospital and patient's residence. All patients had histopathological confirmation of the diagnosis. None of the patients had a drain placed intraoperatively. There was only one readmission at 48 h postoperative; a patient who underwent day surgery came back with cervical edema, which resolved with non-operative treatment. Short-term complications included post-operative local wound infection (8,5%) and hematoma (2,9%), none of which required surgical treatment. CONCLUSIONS Sistrunk procedure without drain placement is safe and can be performed in an outpatient setting.
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Qureshi TA, Suhail A, Zaidi SSA, Siddiq W. Is There Any Benefit of Drain Placement on Postoperative Complications in Patients Undergoing the Sistrunk Procedure? Int Arch Otorhinolaryngol 2015; 19:331-5. [PMID: 26491480 PMCID: PMC4593915 DOI: 10.1055/s-0035-1549156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/23/2015] [Indexed: 10/27/2022] Open
Abstract
Introduction Same-day, outpatient Sistrunk procedure is commonly performed to manage thyroglossal duct cyst anomalies and may lead to postoperative complications. Surgical drains are placed to prevent complications, but recent observations show no advantage and rather increased health care costs and patient discomfort. Objective The study evaluated if drain placement in the Sistrunk procedure offers any benefit on postoperative complications. Methods A retrospective analysis of patient records having undergone same-day, outpatient Sistrunk procedure from 2004 to 2014 was done. Of 58 (38 male and 20 female) patients included, 38 did not have drains placed and the remaining 20 had drains placed. Mean and median age of patients was 18.1 and 13.5 years, respectively. Postoperative complications of patients with drains versus those without drains were statistically analyzed. Results Overall, about 10% of patients had hematoma/seroma (H-S), with 6.9% of patients needing aspiration for H-S; 3.4% had wound infections; and 1.7% had pus formation. No statistically significant differences in Sistrunk-related complications between patient groups (with drain or without drain) were seen using Fisher exact (two-sided) test: H-S (p = 0.08); need for aspiration (p = 0.29); wound infection (p > 0.05); and pus formation (p = 0.35). Chi-square test also did not show any significant difference in the groups in terms of number of follow-ups. Conclusion Surgical placement of a drain in the Sistrunk procedure does not seem to offer any advantage in terms of reducing common postoperative complications. Same-day Sistrunk procedure without any drain placement may be a safer alternative without necessitating hospitalization. More studies with larger sample size are needed for further substantiation.
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Affiliation(s)
- Talha Ahmed Qureshi
- Section of Otolaryngology Head-Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Anwar Suhail
- Section of Otolaryngology Head-Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Sajjad Ali Zaidi
- Section of Otolaryngology Head-Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Wasif Siddiq
- Section of Otolaryngology Head-Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
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