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Bradish T, Hamilton D, O'Hara J. Our experience: Pharyngeal Pouches, a Multimodal Approach to Treatment Under a Single Anaesthetic. A Retrospective Analysis of a Cohort of 105 Cases. Clin Otolaryngol 2024; 49:833-836. [PMID: 39171786 DOI: 10.1111/coa.14209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 06/22/2024] [Accepted: 07/20/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Tom Bradish
- Department of Otorhinolaryngology and Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - David Hamilton
- Department of Otorhinolaryngology and Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - James O'Hara
- Department of Otorhinolaryngology and Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
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Maquet C, Evrard M, Laffouilhere TP, Lacassin M, Nokovitch L, Marie JP, Slama NB, Crampon F, Deneuve S. Comparative analysis of CO2 laser and ultracision harmonic scalpel for endoscopic treatment of Zenker's diverticulum using a propensity score: A retrospective observational study. Am J Otolaryngol 2024; 45:104435. [PMID: 39226772 DOI: 10.1016/j.amjoto.2024.104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/21/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVES Zenker's diverticulum (ZD) is a progressive condition that can cause dysphagia and aspiration. Endoscopic cricopharyngeal myotomy (ECPM) is the gold standard treatment for ZD, but there are various techniques available. We aimed to compare the efficacy and safety of the ultrasonic harmonic scalpel (UHS) versus the CO2 laser (CO2L) for ECPM in ZD. DESIGN We led an observational study. The main composite outcome consisted in persistence of postoperative dysphagia OR recurrence/reoperation of symptomatic ZD within two years postoperatively. Surgery was considered effective when no dysphagia within two years postoperatively. The secondary outcome was the occurrence of acute mediastinitis within 72 h postoperatively. A propensity score was built to adjust for differences observed between non-randomized groups. Additional sensitivity analyses were performed. SETTING All patients with ECPM surgery for ZD were included from 2011 to 2018 in a single tertiary center. Patients with failure of endoscopic exposition were excluded. PARTICIPANTS The study included 86 patients who underwent ECPM with either the CO2L (n = 53) or UHS (n = 33) technique. ZD size and other demographic variables were comparable between the groups. MAIN OUTCOME MEASURES UHS had superior efficacy compared to CO2L (relative risk of failure = 0.29; 95 % confidence interval: 0.05-1.0; p = 0.05), but there was a higher incidence of mediastinitis in the UHS group (12 % vs. 4 %), although this was not statistically significant. RESULTS AND CONCLUSION The UHS technique appears to be an effective technique for ECPM in ZD patients but its safety remains to explore by further larger studies.
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Affiliation(s)
- Charles Maquet
- CHU Rouen, Department of Otorhinolaryngology and Head and Neck Surgery, F-76000 Rouen, France.
| | - Mathieu Evrard
- CHU Rouen, Department of Otorhinolaryngology and Head and Neck Surgery, F-76000 Rouen, France
| | - Thibaut Pressat Laffouilhere
- Clinique Ambroise Paré, Groupe ELSAN, Department of Medical Information, 387 Rte de Saint-Simon, F-31100 Toulouse, France.
| | - Marion Lacassin
- CHU Rouen, Department of Biostatistics, F-76000 Rouen, France.
| | - Lara Nokovitch
- CHU Rouen, Department of Otorhinolaryngology and Head and Neck Surgery, F-76000 Rouen, France
| | - Jean-Paul Marie
- CHU Rouen, Department of Otorhinolaryngology and Head and Neck Surgery, F-76000 Rouen, France.
| | - Neil Ben Slama
- CHU Rouen, Department of Otorhinolaryngology and Head and Neck Surgery, F-76000 Rouen, France.
| | - Frederic Crampon
- CHU Rouen, Department of Otorhinolaryngology and Head and Neck Surgery, F-76000 Rouen, France.
| | - Sophie Deneuve
- CHU Rouen, Department of Otorhinolaryngology and Head and Neck Surgery, F-76000 Rouen, France.
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McKeon M, McCoy N, Johnson C, Allen J, Altaye M, Amin M, Bayan S, Belafsky P, DeSilva B, Dion G, Ekbom D, Friedman A, Fritz M, Giliberto JP, Guardiani E, Kasperbauer J, Kim B, Krekeler BN, Kuhn M, Kwak P, Ma Y, Madden LL, Matrka L, Mayerhoff R, Piraka C, Rosen CA, Tabangin M, Wahab S, Wilson K, Wright C, Young VN, Postma G, Howell RJ. Postoperative Care of Zenker Diverticula: Contemporary Perspective from the Prospective OUtcomes Cricopharyngeaus Hypertonicity (POUCH) Collaborative. Laryngoscope 2024; 134:2678-2683. [PMID: 38146791 DOI: 10.1002/lary.31226] [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: 04/21/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES The aim of the study was to identify trends in postoperative management of persons undergoing surgery for Zenker diverticula (ZD) by evaluating length of stay (LOS), diet on discharge, and imaging with or without surgical complication. METHODS Prospectively enrolled adult patients with cricopharyngeal muscle dysfunction with diverticula undergoing surgery from August 1, 2017 to February 1, 2023 were included. Data were extracted from a multi-institutional REDCap database, summarizing means, medians, percentages, and frequencies. Fisher's exact or chi squared analyses were utilized, as appropriate, to compare subsets of data. Descriptive analysis assessed differences in clinical course and the relationship to postoperative management. RESULTS There were 298 patients with a mean (standard deviation) age of 71.8 (11.2) years and 60% male. Endoscopic surgery was performed in 79.5% (237/298) of patients versus 20.5% (61/298) open surgery. Sixty patients (20.1%) received postoperative imaging, with four leaks identified. Complications were identified in 9.4% of cases (n = 29 complications in 28 patients), more commonly in open surgery. Most (81.2%) patients were discharged within 23 h. About half of patients (49%) were discharged from the hospital on a pureed/liquid diet; 36% had been advanced to a soft diet. In patients without complications, LOS was significantly longer following open cases (p = 0.002); postoperative diet was not different between open and endoscopic (p = 0.26). CONCLUSIONS Overall, most patients are discharged within 23 h without imaging. However, LOS was affected by surgical approach. Postoperative complications are different in endoscopic versus open surgery. Complications with either approach were associated with prolonged LOS, need for imaging, and diet restriction. LEVEL OF EVIDENCE Level III Laryngoscope, 134:2678-2683, 2024.
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Affiliation(s)
- Mallory McKeon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Nicole McCoy
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Christopher Johnson
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University Health, Augusta, Georgia, U.S.A
| | - Jacqui Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Milan Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, U.S.A
| | - Semirra Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Peter Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Davis, California, U.S.A
| | - Brad DeSilva
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A
| | - Greg Dion
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Dale Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Mark Fritz
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Elizabeth Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, U.S.A
| | - Jan Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A
| | - Brittany N Krekeler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Maggie Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Davis, California, U.S.A
| | - Paul Kwak
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, U.S.A
| | - Yue Ma
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A
| | - Ross Mayerhoff
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Cyrus Piraka
- Department of Gastroenterology/Hepatology, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Shaun Wahab
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Keith Wilson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Carter Wright
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Gregory Postma
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University Health, Augusta, Georgia, U.S.A
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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Zhao NW, Stasyuk A, Hernandez BO, Cates DJ, Kuhn MA, Belafsky PC. Objective Fluoroscopic Outcomes After Endoscopic Staple Versus Laser Zenker's Diverticulotomy. Laryngoscope 2023; 133:3057-3060. [PMID: 37129356 DOI: 10.1002/lary.30726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Endoscopic Zenker's diverticulotomy (EZD) is typically performed via stapling (endoscopic staple diverticulotomy; ESD) or CO2 laser (endoscopic laser diverticulotomy; ELD). Conflicting reports exist on which approach provides optimal outcomes. This investigation compared objective fluoroscopic data between ESD and ELD. METHODS A retrospective review of all patients undergoing primary EZD at a tertiary center between January 1, 2014 and January 10, 2022 was performed. Patients undergoing ESD and ELD were matched by preoperative diverticulum size. Primary outcome measures were postoperative diverticulum size and change in diverticulum size from pre- to postoperative swallowing fluoroscopy. Secondary outcome measures were the Eating Assessment Tool (EAT-10) score, penetration aspiration scale (PAS), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo). RESULTS Thirteen matched pairs with complete fluoroscopic data were identified. The mean (±SD) age of the cohort was 74.0 (±8.5) years. There were no age or gender differences between groups (p > 0.05). The mean pre-operative ZD size was 1.98 (±0.69) cm for ESD and 1.97 (±0.72) cm for ELD; the mean postoperative size was 0.84 (±0.62) cm for ESD and 0.34 (±0.27) cm for ELD (p < 0.05). Mean diverticulum size improved by 1.14 (±0.59) cm after ESD and 1.62 (±0.59) cm after ELD (p < 0.05). There were no significant differences in postoperative EAT-10, PAS, PCR, or PESo between groups. CONCLUSION The data suggest that endoscopic laser Zenker's diverticulotomy results in a greater improvement in diverticulum size than endoscopic staple diverticulotomy. The data did not suggest a difference in postoperative dysphagia symptom scores or other objective fluoroscopic parameters between staple and laser diverticulotomy. LEVEL OF EVIDENCES Level 3 Laryngoscope, 133:3057-3060, 2023.
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Affiliation(s)
- Nina W Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Anastasiya Stasyuk
- School of Medicine, University of California, Davis, Sacramento, California, U.S.A
| | - Brian O Hernandez
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Peter C Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
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5
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Silvino do Monte E, Ide E, Sagae VMT, Ribeiro IB, Funari MP, de Oliveira PVAG, de Moura EGH. Endoscopic stag beetle knife treatment for symptomatic Zenker's diverticulum. Endoscopy 2021; 53:E318-E319. [PMID: 33075827 DOI: 10.1055/a-1273-7390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Epifanio Silvino do Monte
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edson Ide
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Massaro Takamatsu Sagae
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Crawley B, Dehom S, Tamares S, Marghalani A, Ongkasuwan J, Reder L, Ivey C, Amin M, Fritz M, Pitman M, Tulunay-Ugur O, Weissbrod P. Adverse Events after Rigid and Flexible Endoscopic Repair of Zenker’s Diverticula: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2019; 161:388-400. [DOI: 10.1177/0194599819839991] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To determine adverse events after endoscopic flexible vs endoscopic rigid cricopharyngeal myotomy for treatment of Zenker’s diverticulum (ZD). Data Sources Systematic review of MEDLINE, Web of Science, CINAHL, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for all years according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional studies were identified from review citations and a by hand search of manuscripts referencing ZD. Review Methods A structured literature search was conducted to identify studies for this systematic review. Methodological Index for Non-randomized Studies (MINORS) criteria were applied to assess study quality. For inclusion, each study had to provide data for at least 10 adult patients who had undergone endoscopic ZD repair reporting clear association with the postprocedure course in each case. Data extracted included all reported adverse events, recurrences, follow-up, and operative times. Results In total, 115 studies were included. All but 8 were retrospective case series. Sixty-one reported series of patients after rigid endoscopic stapler repair, 31 after rigid laser repair, and 13 with other rigid endoscopic instruments. Twenty-nine flexible endoscopic studies were included. Mortality, infection, and perforation were not significantly more likely in either the rigid or the flexible group, but bleeding and recurrence were more likely after flexible endoscopic techniques (20% vs <10% and 4% vs 0%, respectively). Dental injury and vocal fold palsy were reported rarely in the rigid endoscopic groups. Conclusions Adverse events are rare after endoscopic Zenker’s repair. The flexible approach minimizes exposure limitations and can be completed in some patients without general anesthesia. Transoral rigid approaches result in fewer revision surgeries compared with flexible diverticulotomy.
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Affiliation(s)
- Brianna Crawley
- Department of Otolaryngology–Head and Neck Surgery, Loma Linda University Voice and Swallowing Center, Loma Linda, California, USA
| | - Salem Dehom
- School of Nursing, Loma Linda University, Loma Linda, California, USA
| | - Shanalee Tamares
- School of Medicine and School of Behavioral Sciences, Loma Linda University, Loma Linda, California, USA
| | - Abdullah Marghalani
- Preventive Dentistry Department, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Julina Ongkasuwan
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
| | - Lindsay Reder
- Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chandra Ivey
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine Mount Sinai, New York, New York, USA
| | - Milan Amin
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Mark Fritz
- Department of Otolaryngology–Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Michael Pitman
- Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, Columbia University, New York, New York, USA
| | - Ozlem Tulunay-Ugur
- Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, University of Arkansas, Little Rock, Arkansas
| | - Philip Weissbrod
- San Diego Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, University of California, San Diego, California, USA
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Hering S, Wiegand S. Systemic inflammatory response after endoscopic surgery of Zenker's diverticulum. ACTA OTORHINOLARYNGOLOGICA ITALICA 2019; 39:230-234. [PMID: 30745590 PMCID: PMC6734204 DOI: 10.14639/0392-100x-1576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 12/01/2017] [Indexed: 11/23/2022]
Abstract
Zenker’s diverticulum can be treated with a carbon dioxide laser or linear stapling device. A retrospective study on patients undergoing elective surgery for Zenker`s diverticulum with carbon dioxide laser or stapler was performed to analyse possible differences in inflammatory responses during the postoperative period. Leucocyte counts and C-reactive protein levels in peripheral blood were measured before and on days 1, 2, 3 and 5 after the operation. Statistical analysis was performed using the Mann-Whitney U-test. Of 34 patients, 16 were treated by laser and 18 by stapler. Age, sex ratio and ASA grade did not differ between the groups. Postoperative leukocytosis was significantly milder in the stapler group compared with patients who were treated by carbon dioxide laser. The mean C-reactive protein (CRP) level on day 1, 2 and 3 after surgery was significantly higher in the CO2 laser group than in the stapler group. Leukocyte counts recovered on day 3 after surgery in both groups while CRP levels did not decline to preoperative levels at day 5 after the operation in either group. No inflammatory complications such as mediastinitis or pneumonia occurred. In conclusion, the inflammatory response in the early period after carbon dioxide laser diverticulotomy of Zenker’s diverticulum is higher than after stapler-assisted surgery of Zenker’s diverticulum.
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Affiliation(s)
- S Hering
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - S Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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Colpaert C, Vanderveken OM, Wouters K, Van de Heyning P, Van Laer C. Changes in Swallowing-related Quality of Life After Endoscopic Treatment For Zenker’s Diverticulum Using SWAL-QOL Questionnaire. Dysphagia 2017; 32:339-344. [DOI: 10.1007/s00455-017-9782-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
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Hoffmann M, Fazel A, Mews KG, Ambrosch P. 32 years of experience with CO2
-LASER-assisted treatment for Zenker's Diverticulum - an update of 227 patients treated in Kiel. Clin Otolaryngol 2016; 42:592-596. [DOI: 10.1111/coa.12777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery; Christian-Albrechts-University of Kiel; Kiel Germany
| | - A. Fazel
- Department of Otorhinolaryngology, Head and Neck Surgery; Christian-Albrechts-University of Kiel; Kiel Germany
| | - K.-G. Mews
- Department of Otorhinolaryngology, Head and Neck Surgery; Christian-Albrechts-University of Kiel; Kiel Germany
| | - P. Ambrosch
- Department of Otorhinolaryngology, Head and Neck Surgery; Christian-Albrechts-University of Kiel; Kiel Germany
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10
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Barton MD, Detwiller KY, Palmer AD, Schindler JS. The safety and efficacy of endoscopic Zenker's diverticulotomy: A cohort study. Laryngoscope 2016; 126:2705-2710. [DOI: 10.1002/lary.26046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/09/2016] [Accepted: 03/28/2016] [Indexed: 11/07/2022]
Affiliation(s)
| | - Kara Y. Detwiller
- Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland Oregon U.S.A
| | - Andrew D. Palmer
- Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland Oregon U.S.A
| | - Joshua S. Schindler
- Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland Oregon U.S.A
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11
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Bencini L, Moraldi L, Bartolini I, Coratti A. Esophageal surgery in minimally invasive era. World J Gastrointest Surg 2016; 8:52-64. [PMID: 26843913 PMCID: PMC4724588 DOI: 10.4240/wjgs.v8.i1.52] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/18/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasive surgery (MIS) mainly include reductions of postoperative complications, length of hospital stay, and pain and better cosmetic results. All of these benefits could potentially be of great interest when dealing with the esophagus due to the potentially severe complications that can occur after conventional surgery. Moreover, robotic platforms are expected to reduce many of the difficulties encountered during advanced laparoscopic and thoracoscopic procedures such as anastomotic reconstructions, accurate lymphadenectomies, and vascular sutures. Almost all esophageal diseases are approachable in a minimally invasive way, including diverticula, gastro-esophageal reflux disease, achalasia, perforations and cancer. Nevertheless, while the limits of MIS for benign esophageal diseases are mainly technical issues and costs, oncologic outcomes remain the cornerstone of any procedure to cure malignancies, for which the long-term results are critical. Furthermore, many of the minimally invasive esophageal operations should be compared to pharmacologic interventions and advanced pure endoscopic procedures; such a comparison requires a difficult literature analysis and leads to some confounding results of clinical trials. This review aims to examine the evidence for the use of MIS in both malignancies and more common benign disease of the esophagus, with a particular emphasis on future developments and ongoing areas of research.
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12
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Visser LJ, Hardillo JAU, Monserez DA, Wieringa MH, Baatenburg de Jong RJ. Zenker's diverticulum: Rotterdam experience. Eur Arch Otorhinolaryngol 2015; 273:2755-63. [PMID: 26576954 PMCID: PMC4974285 DOI: 10.1007/s00405-015-3825-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/29/2015] [Indexed: 11/23/2022]
Abstract
Different surgical techniques exist for the treatment of Zenker’s diverticulum (ZD), of which minimally invasive techniques have become the standard. We reviewed our experience with management and treatment of ZD and sought to determine what type of treatment is most effective and efficient. We selected patients who underwent treatment for ZD between January 2004 and January 2014 at our tertiary referral center. All procedures were performed by ENT surgeons. The medical records were reviewed for pre- and intraoperative characteristics and follow-up. Of our 94 patients (58 male, 36 female), 75 underwent endoscopic cricopharyngeal myotomy (42 stapler, 33 laser) and 6 received treatment via transcervical approach. 13 interventions were aborted. Mean operating time was 49.0 min for stapler, 68.3 for laser and 124.0 for the transcervical approach. Its respective median post-operative admission durations were 2.0, 3.0 and 3.0 days. After the first treatment, of the 75 endoscopic procedures, 45 patients (23 stapler, 22 laser) had complete symptom resolution. In the transcervical group 4 (67 %) patients were symptom free and one patient died of complications. In the endoscopically treated patients, ten complications occurred, of which 8 G1 and 2 G2 (Clavien Dindo classification). In the transcervical group 2 complications occurred, 1 G3b and 1 G5. Both endoscopic techniques provide efficient management of Zenker’s diverticulum with the stapler-assisted modality providing a shorter surgery duration and hospital admission. Although there is no significant difference in terms of complications or recurrence rates for both endoscopic techniques, it seems that stapler patients are at higher risk of having a re-intervention and of having more severe complications.
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Affiliation(s)
- L J Visser
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands.
| | - J A U Hardillo
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - D A Monserez
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - M H Wieringa
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
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Abstract
AbstractBackground:Pharyngeal pouches have been recognised as a cause of dysphagia for centuries and have been treated in a variety of ways over that time.Objective:This article aimed to analyse the results of surgery by a variety of techniques, as performed by one surgeon.Method:A retrospective analysis of a case series was conducted, analysing the variables of patient age, sex, type of surgery, length of hospital stay, leak, recurrence and other complications.Results:A total of 121 patients were treated by 135 operations. There were no leaks in the group treated by endoscopic stapling and this group also had a significantly shorter hospital stay. As for recurrence, the lowest rate appeared to be in the group treated by excision of the pouch.Conclusion:The techniques used by the author all still seem to have a role in the management of pharyngeal pouch, with the endoscopic stapling approach associated with a low rate of complications and short hospital stay.
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Laser surgery for Zenker's diverticulum: European combined study. Eur Arch Otorhinolaryngol 2015; 273:183-8. [PMID: 25567345 DOI: 10.1007/s00405-014-3486-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 12/25/2014] [Indexed: 12/17/2022]
Abstract
Surgical intervention is the gold standard of treatment for Zenker's diverticulum. The aim of this study was to examine the role of laser surgery in a large number of patients with this pathological entity. The data of 91 consecutive patients treated due to Zenker's diverticulum with the aid of CO2 laser in three institutions (Homburg/Saar and Marburg, Germany/Athens, Greece) during the last 10 years were retrospectively analyzed. Parameters examined were sex, age, preoperative symptoms, length of operation and complications, revision surgery necessity and degree of patient satisfaction. All patients had a minimum follow-up of one year. Dysphagia was the most common preoperative symptom (78 %). The most common minor complication was dental injury (6.6 %), but a serious complication in form of emphysema was observed in only two patients (2.2 %). A surgical revision was necessary in 8 (8.8 %) of the treated patients. The majority of treated patients was free of symptoms (86.8 %), or presented mild symptoms (9.9 %) one year after intervention, and only three patients (3.3 %) were dissatisfied. Our study shows that laser treatment of Zenker's diverticulum is an efficient operative technique associated with low complications rates and significant improvement of patients' symptoms in most of the examined cases.
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Anagiotos A, Feyka M, Eslick GD, Lichtenstein T, Henning TD, Guntinas-Lichius O, Hüttenbrink KB, Preuss SF. Long-term symptom control after endoscopic laser-assisted diverticulotomy of Zenker's diverticulum. Auris Nasus Larynx 2014; 41:568-71. [DOI: 10.1016/j.anl.2014.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/01/2014] [Accepted: 06/13/2014] [Indexed: 11/28/2022]
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16
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Systematic review on treatment of Zenker’s diverticulum. Eur Arch Otorhinolaryngol 2014; 272:3095-107. [DOI: 10.1007/s00405-014-3267-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/29/2014] [Indexed: 12/12/2022]
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17
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Minovi CM, Minovi A, Dost P. Suture of the mucosa after the endoscopic LASER mucomyotomy of Zenker's diverticulum. Eur Arch Otorhinolaryngol 2014; 272:2947-52. [PMID: 25164870 DOI: 10.1007/s00405-014-3247-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
The treatment of choice of Zenker's diverticulum is the rigid endoscopic mucomyotomy. At our ENT department, we usually perform an endoscopic mucosal suture after the myotomy. We diagnosed 49 patients and treated 39 patients between 2003 and 2013 due to a Zenker's diverticulum. We used the classification of Brombart to determine the size of the diverticulum. Surgery was performed as an endoscopic LASER mucomyotomy with mucosal sutures or as an open approach with diverticulectomy and myotomy. Patients were phoned to ask for their complaints postoperatively. The symptoms were classified using a visual scale from 0 (no complaint) until 10 (same or more complaints than before the surgery). The distribution of the diverticulum's size was: 6 patients Brombart I, 11 patients Brombart II, 14 patients Brombart III and 18 patients Brombart IV. 10 patients did not undergo surgery. With 33 patients, we performed an endoscopic operation and 6 patients underwent an open approach. The scale of postoperative complaints was the following: 20 patients (0/10), 12 patients (1/10 or 2/10), 3 patients (3/10), 1 patient (6/10) and 1 patient (10/10). None of the patients suffered from severe complications such as mediastinitis. In 85% of the cases, an endoscopic approach could be performed. Postoperatively, 94% of the patients did not have any or just mild complaints. The risk of severe complications or recurrence of the diverticulum is low. The mucosal suture might reduce the risk of infections.
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Affiliation(s)
- Carolina Morales Minovi
- Department of Otorhinolaryngology, Marienhospital, Gelsenkirchen, Virchowstrasse 135, 45886, Gelsenkirchen, Germany,
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Leibowitz JM, Fundakowski CE, Abouyared M, Rivera A, Rudman J, Lo KM, Weed D, Civantos F. Surgical Techniques for Zenker's Diverticulum: A Comparative Analysis. Otolaryngol Head Neck Surg 2014; 151:52-8. [PMID: 24705225 DOI: 10.1177/0194599814529405] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/06/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the different modalities for treatment of Zenker's diverticulum and the associated clinical outcomes. STUDY DESIGN Case series with chart review. SETTING Tertiary care hospital. SUBJECTS AND METHODS Between 1995 and 2011, 164 patients underwent surgery for Zenker's diverticulum (stapler, n = 69; laser, n = 68; open, n = 27). Patient sociodemographics, medical comorbidities, pre- and postoperative subjective dysphagia and regurgitation score, complications, length of stay, time to oral intake, and recurrence were reviewed for each surgical modality. RESULTS No statistically significant difference in diverticulum prevalence was associated with age, gender, or treatment group. Mean length of hospital stay was not significantly different between the 3 groups (P = .14). A significant difference in time to oral intake was observed in the laser group compared with the other 2 groups (P = .012). No significant difference in recurrence (P = .21) or complication (P = .12) rates was identified between the 3 groups. Although all 3 groups demonstrated a significant decrease between preoperative and postoperative dysphagia and regurgitation scores, the degree of improvement was not significant when the 3 groups were compared. CONCLUSION There is no single "best" approach to Zenker's diverticulum. The open, laser, and stapler methods are equally effective and have similar complication rates.
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Affiliation(s)
- Jason M Leibowitz
- Department of Otolaryngology-Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Andrew Rivera
- Department of Otolaryngology-Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Jason Rudman
- Department of Otolaryngology-Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Ka-Ming Lo
- Department of Epidemiology and Public Health, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Donald Weed
- Department of Otolaryngology-Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
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19
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Zenker's diverticulum: carbon dioxide laser endoscopic surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:516231. [PMID: 24729975 PMCID: PMC3963375 DOI: 10.1155/2014/516231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/28/2014] [Indexed: 11/25/2022]
Abstract
Nowadays endoscopic diverticulotomy is the surgical approach of the first choice in treatment of Zenker's diverticulum. We report our experience with this procedure and try to sum up recent recommendations for management of surgery and postoperative care. Data of 34 patients with Zenker's diverticulum, treated by endoscopic carbon dioxide laser diverticulotomy at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic, were prospectively stored and followed in relatively short period from May 2009 to December 2013. The average length of diverticulum was 32 mm. The average duration of surgery was 32 min. The patients were fed via feeding tube for 6.1 days and antibiotics were administered for 7 days. Mean hospitalization time was 7.4 days. We observed one transient recurrent laryngeal nerve paralysis and no other serious complications. Recurrence rate was 3%. We recommend complete transection of the diverticular septum in one procedure, systemic antibiotic treatment and exclusion of transoral intake for minimally 5 days, and contrast oesophagogram before resumption of oral intake to exclude fistula. Open diverticulectomy should be reserved for cases with inadequate endoscopic exposure and for revision surgery for multiple recurrences from endoscopic diverticulotomies.
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20
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Parker NP, Misono S. Carbon dioxide laser versus stapler-assisted endoscopic Zenker's diverticulotomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2014; 150:750-3. [PMID: 24496741 DOI: 10.1177/0194599814521554] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate outcomes following endoscopic management of Zenker's diverticula using a carbon dioxide laser (CO2) or stapler-assisted technique, a systematic review and meta-analysis were conducted. Seven retrospective, uncontrolled case series including 391 procedures met selection criteria. No higher quality studies were identified. Outcomes favoring the stapler technique included a shorter duration of nil per os (NPO) status (2 studies), length of hospitalization (LOH, 2 studies), and fewer postoperative fevers and abnormal chest x-rays (1 study). Outcomes favoring the CO2 technique included greater improvement in postoperative dysphagia and regurgitation scores (2 studies) and a lower revision rate (1 study). Meta-analysis demonstrated increased nondental complications in the CO2 group (odds ratio 3.81; 95% confidence interval, 1.37-10.59; P = .01) but no difference in duration of NPO (P = .06), LOH (P = .07), overall complications (P = .08), dental complications (P = .57), major complications (P = .38), or revision surgery (P = .82). Implications are limited by the quality of studies identified.
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Affiliation(s)
- Noah P Parker
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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21
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Sayles M, Harrison L, McGlashan JA, Grant DG. Zenker's diverticulum complicating achalasia: a 'cup-and-spill' oesophagus. BMJ Case Rep 2013; 2013:bcr-2013-200702. [PMID: 24334471 DOI: 10.1136/bcr-2013-200702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 72-year-old woman presented with long-standing gastro-oesophageal reflux, regurgitation of swallowed food and worsening cervical dysphagia. Fluoroscopic barium oesophagography revealed a posterolateral pharyngeal pouch (Zenker's diverticulum (ZD)) complicating a 'cup and spill' oesophageal deformity with a smoothly tapered segment at the gastro-oesophageal junction. CT and high-resolution manometry confirmed that the underlying abnormality was a massively dilated oesophagus with aperistalsis and pan-oesophageal pressurisation, consistent with a diagnosis of oesophageal achalasia (type II). She underwent endoscopic stapled diverticulotomy, with good symptomatic relief. We discuss the aetiology of ZD, its management and the association here with oesophageal achalasia.
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Affiliation(s)
- Mark Sayles
- Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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22
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Pollei TR, Hinni ML, Hayden RE, Lott DG, Mors MB. Comparison of Carbon Dioxide Laser—Assisted versus Stapler-Assisted Endoscopic Cricopharyngeal Myotomy. Ann Otol Rhinol Laryngol 2013; 122:568-74. [DOI: 10.1177/000348941312200906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives: We directly compared endoscopic carbon dioxide (CO2) laser and stapler treatment methods for both cricopharyngeal hypertrophy (CPH) and Zenker's diverticulum (ZD). Methods: We performed a single-institution retrospective chart review of 153 patients who underwent either CO2 laser–assisted or stapler-assisted endoscopic cricopharyngeal myotomy (CPM). Results: Isolated CPH was more likely to be treated with the CO2 laser than by stapler techniques. The ZD pouch size decreased significantly after surgery in both laser (p = 0.04) and stapler (p = 0.008) groups. The average duration of the procedure for CPM was longer for the laser than for the stapler (p = 0.01). Both techniques were successful when used in revision procedures. The overall complication rates were not statistically significantly different. Laser surgery trended toward a higher rate of major complications (2.4% versus 0%). Symptomatic recurrence was more likely after stapler surgery (p = 0.002). The rates of revision surgery were similar in the two groups (3.3% for laser and 4.3% for stapler). Conclusions: In the treatment of isolated CPH or ZD, stapler-assisted endoscopic surgery results in a shorter operative time, whereas laser-assisted CPM results in a decreased incidence of symptomatic recurrence.
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23
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Lavin JM, Tieu D, Maddalozzo J. Complementary and integrative treatments: swallowing disorders. Otolaryngol Clin North Am 2013; 46:447-60. [PMID: 23764821 DOI: 10.1016/j.otc.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Swallowing disorders are associated with many disease processes and are associated with significant morbidity and mortality. This article provides information regarding the various causes of swallowing disorders as well as medical, surgical, and integrative approaches to their management.
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Affiliation(s)
- Jennifer M Lavin
- Department of Otolaryngology-Head and Neck Surgery, Northwestern, University Feinberg School of Medicine, Chicago, IL 60611, USA.
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24
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Anagiotos A, Feyka M, Gostian AO, Lichtenstein T, Henning TD, Guntinas-Lichius O, Hüttenbrink KB, Preuss SF. Endoscopic laser-assisted diverticulotomy without versus with wound closure in the treatment of Zenker's diverticulum. Eur Arch Otorhinolaryngol 2013; 271:765-70. [PMID: 23740427 DOI: 10.1007/s00405-013-2579-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/27/2013] [Indexed: 12/31/2022]
Abstract
The aim of the present study was to compare the modifications of endoscopic laser-assisted diverticulotomy regarding closure of mucosal wound at the cricopharyngeal bridge. The results of 62 cases after endoscopic laser-assisted diverticulotomy without and with wound closure were retrospectively compared. After laser-assisted transection of the cricopharyngeal bridge, the mucosa wound was left open (OW) in 35 cases (56%), whereas a closure of the mucosa wound (CW) with sutures and fibrin glue was performed in 27 patients (44%). Duration of hospitalization, residual diverticular sac rate and occurrence of complications did not differ significantly between the two groups. Mean surgical time was significantly less in the OW cases. According to these results, it can be assumed that readapting and sealing the wound after transecting the cricopharyngeal bridge does not significantly reduce the complication rate. It does, however, extend the length of surgery and increases the cost of the procedure.
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Affiliation(s)
- A Anagiotos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50937, Cologne, Germany,
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25
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Herrero Egea A, Pérez Delgado L, Tejero-Garcés Galve G, Guallar Larpa M, Orte Aldea C, Ortiz García A. Treatment of Zenker's Diverticulum: Comparison of Different Techniques. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tratamiento del divertículo de Zenker: comparación de diferentes técnicas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 64:1-5. [DOI: 10.1016/j.otorri.2012.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/02/2012] [Accepted: 06/06/2012] [Indexed: 11/18/2022]
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27
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Bergeron JL, Long JL, Chhetri DK. Dysphagia characteristics in Zenker's diverticulum. Otolaryngol Head Neck Surg 2012; 148:223-8. [PMID: 23128778 DOI: 10.1177/0194599812465726] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate dysphagia characteristics in patients with Zenker's diverticulum (ZD). STUDY DESIGN Case series with chart review. SETTING Outpatient tertiary care dysphagia clinic. SUBJECTS AND METHODS All ZD cases surgically treated over a 6-year period were identified and reviewed for dysphagia history and dysphagia characteristics on initial presentation using fiber-optic endoscopic evaluation of swallowing (FEES). Dysphagia symptoms and swallowing abnormalities were compared across groups based on diverticulum size (small <1 cm, medium 1-3 cm, and large >3 cm). RESULTS Forty-six patients underwent a total of 52 procedures during the study period. ZD size was available in 49 cases (6 small, 26 medium, 17 large). Regurgitation symptoms were less frequent in patients with small (17%) compared with medium (68%) or large diverticula (76%; P = .03). Postswallow hypopharyngeal reflux (PSHR) was less frequent in patients with small (17%) compared with medium (91%) and large diverticula (87%; P < .01). PSHR was present on all FEES available for patients who presented with a recurrent or residual ZD (n = 7). In all cases, PSHR resolved after successful treatment of ZD. Pharyngeal residue indicating possible weakness was present in 24% of all patients at initial presentation. CONCLUSIONS Preoperative assessment of dysphagia characteristics in ZD patients reveals that PSHR is predictive of a ZD larger than 1 cm and may be useful in surgical planning. PSHR is also helpful in identifying patients with recurrent or residual symptomatic ZD following surgical treatment. Pharyngeal weakness is present in a subset of ZD patients.
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Affiliation(s)
- Jennifer L Bergeron
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California 90095, USA.
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28
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Herbella FAM, Patti MG. Modern pathophysiology and treatment of esophageal diverticula. Langenbecks Arch Surg 2011; 397:29-35. [PMID: 21887578 DOI: 10.1007/s00423-011-0843-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/22/2011] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Esophageal diverticula are rare. They may occur in the pharyngoesophageal area (Zenker's), midesophagus, or distally (epiphrenic). A motility disorder (either at the level of the esophageal sphincters or body) is frequently associated with esophageal diverticula. The risk of malignant transformation is low. METHODS A literature search was performed using Medline/PubMed database. RESULTS The treatment of esophageal diverticula must be based on the pathophysiology and natural history of the disease: (a) asymptomatic diverticula do not need a specific treatment, (b) small diverticula may be left in place and not resected, (c) medium-size diverticula may be either treated by diverticulectomy, diverticulopexy, or esophagodiverticulostomy in case of pharyngoesophageal diverticula, (d) resection is probably the ideal therapy for larger diverticula, and (e) a myotomy should always be included to the procedure. CONCLUSIONS Due to its rarity, esophageal diverticula must be treated by esophageal surgeons since even in experienced hands the complication rate can be significant.
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Affiliation(s)
- Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
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29
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Abstract
BACKGROUND A pharyngeal pouch is an out-pouching or pocket that develops from the posterior wall of the pharynx just above the entrance to the oesophagus (gullet). Pouches may give rise to difficulty in swallowing, sensation of a lump in the throat or of food sticking in the throat and may lead to troublesome regurgitation of food. Food may enter the pouch rather than passing down the oesophagus and this and regurgitation may result in weight loss, hoarseness of voice and/or recurrent chest infections. The management of patients with a pharyngeal pouch may be either conservative or surgical. The surgical management can be further divided into two broad categories: endoscopic and open procedures. In the first half of the twentieth century an open surgical approach to the pouch was most frequently used, and remains common in some parts of the world. In recent decades endoscopic procedures (where the approach is made through the mouth) have become popular. The superiority of one approach over another has yet to be clearly demonstrated. OBJECTIVES To assess the effectiveness and safety of open and endoscopic surgical procedures for the management of a pharyngeal pouch. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2004, MEDLINE (1966 to 2004) and EMBASE (1974 to 2004). Reference lists of all identified trials and previous reviews were searched for additional trials. Further electronic searches for key authors identified were made. There were no language restrictions. The date of the last search was September 2004. SELECTION CRITERIA We sought to identify all randomised controlled trials (RCTs) comparing two or more interventions. DATA COLLECTION AND ANALYSIS Three reviewers assessed the eligibility of trials for inclusion in the review, based on pre-determined criteria. MAIN RESULTS No trials were identified which fulfilled the criteria. AUTHORS' CONCLUSIONS There is no evidence from high quality randomised controlled trials to demonstrate the effectiveness of endoscopic compared with open procedures for pharyngeal pouch. There is no good evidence to establish whether one endoscopic procedure is superior to another.
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Affiliation(s)
- P Sen
- ENT Department, Whipps Cross Hospital, Leytonstone, London, UK, E11 1NR.
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