Surgical strategy not important- Magnifying equipment use during preauricular fistula surgery may diminish recurrence rate

The researchers in their study published in BMC Surgery, therefore, suggest that surgeons can select their preferred approaches based on patient-specific situations and their practices. However, the use of magnifying equipment during surgery is associated with a reduced risk of recurrence.

Congenital preauricular fistula refers to a congenital malformation observed in the field of otolaryngology. Surgery remains the most effective method of treatment for complex preauricular fistulas that are susceptible to infection and pose challenges in complete removal during surgery, leading to a high postoperative recurrence rate. Currently, the recurrence after preauricular fistula resection is a considerable clinical concern. To address this concern, the identification of an effective method is required to reduce the risk of recurrence by selecting appropriate surgical techniques.

Therefore, to enhance the clinical knowledge and contribute to strategies for reducing recurrence, Xianhai Zeng, Institute of E.N.T Shenzhen, Longgang E.N.T Hospital, Guangdong Province, People’s Republic of China, and colleagues aimed to assess the effects of surgical timing and approach for preauricular fistula on the postoperative suture removal time, operative duration, and postoperative recurrence rate. To analyze the potential effects of different surgical strategies on these critical outcomes, a 12-year single-centre clinical observation was conducted.

In the retrospective study, the researchers examined clinical data from 576 (782 ears) patients who underwent surgical resection for preauricular fistulas. Based on differences in surgical techniques, operative duration, and the use of intraoperative magnifying equipment, the patients were classified into several groups. Furthermore, the specific data on operative duration postoperative recurrence rate, and postoperative suture removal time were also recorded.

The study led to the following findings:

• The average operative duration for 782 ears and the average time required for postoperative suture removal were determined to be (34.57 ± 4.25) min and (3.62 ± 0.76) days, respectively.
• Among the cases examined, recurrence occurred in 13 ears, but all of them were cured after a second surgery, resulting in a recurrence rate of 1.67%.
• The operative and postoperative suture removal time was prolonged during the infection period.
• The postoperative recurrence rate was significantly higher in the absence of magnifying equipment, as compared to those with the use of a microscope with 2.5× magnification.
• No statistically significant differences were noted in the recurrence rate when comparing different anaesthesia methods and surgical incision types, as well as the intraoperative use of methylene blue, and partial removal of cartilage of the pedicle.

"The use of magnifying equipment during surgery has shown the potential to diminish the recurrence rate, underscoring its clinical utility as an adjunctive tool to enhance surgical outcomes," the researchers concluded.

Reference:

Li, K., Hao, Y., Zhao, J. et al. Surgical treatment of preauricular fistulas: a 12-year single-center clinical observation. BMC Surg 23, 297 (2023). https://doi.org/10.1186/s12893-023-02198-x