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Open vs Percutaneous Management of Pediatric Ganglia: A 12-Year Comparison
Austin D. Williams, BS; Alexandra L. Martinez, BA; Yang Ding, BA; Diego M Quirarte, BA; Alisa Lu, BA, BSA; Olohirere Tomisin Ezomo, MD, MPH; Christine Yin, MD
Baylor College of Medicine, Houston, TX
INTRODUCTION Ganglia are the most common soft tissue mass of the pediatric hand and wrist. While many resolve spontaneously, persistent ganglia are treated with surgical excision. Recently, percutaneous ultrasound-guided fenestration of ganglia (PUGG) has been suggested as a minimally invasive alternative to surgery. This study aims to compare outcomes between surgery and PUGG. METHODS A retrospective chart review was conducted for pediatric patients undergoing hand or wrist ganglia excision and/or PUGG from September 2012 to April 2024 at a single tertiary pediatric hospital. Patient demographics, treatment history, operative details, complications and recurrence were collected. Continuous variables were analyzed using independent t-tests, and categorical variables were analyzed using chi-square and Fisher exact tests. RESULTS 301 patients were included in this study, representing 311 ganglia. Female to male ratio was 2:1. Average age was 12.7 years (SD 3.98) at the time of treatment, and length of follow up was 6.4 months (SD 11.9). Most ganglia were seen in the dorsal wrist (66.2%), followed by the volar wrist (28.6%) (Table 1). 208 patients (66.9%) underwent surgical excision, while 95 (66.9%) underwent PUGG. There were no differences in sex, race, ethnicity, or social vulnerability index. Surgical patients were on average 1 year younger than those receiving PUGG (p=0.0404). Surgical patients had more frequently failed prior nonsurgical therapy (p=0.0038), but prior surgery was rare amongst both modalities. Patients who underwent PUGG experienced recurrence 2.2 times more frequently than surgical patients (p=0.0001). There were no differences in the frequency of re-operation between modalities (Table 2). CONCLUSIONS Aside from having failed prior nonsurgical therapy and being younger, there were no demographic differences between patients undergoing surgery and PUGG. Our study demonstrates the rate of recurrence following surgical excision to be clinically and statistically lower than PUGG, though PUGG represents a more successful minimally invasive treatment modality than prior techniques. Ongoing research will incorporate a larger sample and cost-analyses.
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