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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References
Ferreira LE, Simmons DT, Baron TH (2008) Zenker’s diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus 21:1–8
Allen J, White CJ, Leonard R, Belafsky PC (2010) Effect of cricopharyngeus muscle surgery on the pharynx. Laryngoscope 120:1498–1503
Van Overbeek JJ (1994) Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol 103:178–185
Lippert BM, Folz BJ, Gottschlich S, Werner JA (1997) Microendoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser. Lasers Surg Med 20:394–401
Lippert BM, Werner JA (1995) Results and surgical experiences in web transsection of hypopharyngeal (Zenker) diverticulum with the CO2 laser. HNO 43:605–610
Bizzotto A, Iacopini F, Landi R, Costamagna G (2013) Zenker’s diverticulum: exploring treatment options. Acta Otorhinolaryngol Ital. 33:219–229
Yuan Y (2013) Zhao YF, Hu Y, Chen LQ: surgical treatment of Zenker’s diverticulum. Dig Surg 30:214–225
Mosher H (1917) Webs and pouches of the oesophagus, their diagnosis and treatment. Surg Gynecol Obstet 25:175–187
Anagiotos A, Feyka M, Gostian AO, Lichtenstein T, Henning TD, Guntinas-Lichius O, Hüttenbrink KB, Preuss SF (2014) Endoscopic laser-assisted diverticulotomy without versus with wound closure in the treatment of Zenker’s diverticulum. Eur Arch Otorhinolaryngol 271:765–770
Murer K, Soyka MB, Broglie MA, Huber GF, Stoeckli SJ. Zenker’s diverticulum: outcome of endoscopic surgery is dependent on the intraoperative exposure. Eur Arch Otorhinolaryngol. 2014. (Epub ahead of print)
Mulder CJ, den Hartog G, Robijn RJ, Thies JE (1995) Flexible endoscopic treatment of Zenker’s diverticulum: a new approach. Endoscopy 27:438–442
Tang SJ (2014) Flexible endoscopic Zenker’s diverticulotomy: approach that involves thinking outside the box (with videos). Surg Endosc 28:1355–1359
Law R, Baron TH (2013) Transoral flexible endoscopic therapy of Zenker’s diverticulum. Dig Surg 30:393
Adam SI, Paskhover B, Sasaki CT (2012) Laser versus stapler outcomes in endoscopic repair of Zenker diverticulum. Laryngoscope 122:1961–1966
Koch M, Mantsopoulos K, Velegrakis S, Iro H, Zenk J (2011) Endoscopic laser-assisted diverticulotomy verus ope surgical approach in the treatment of Zenker’s diverticulum. Laryngoscope 121:2090–2094
Bergeron JL, Chhetri DK (2014) Indications and outcomes of endoscopic CO2 cricopharyngeal myotomy. Laryngoscope 124:950–954
Krespi Y, Kacker A, Remacle M (2002) Endoscopic treatment of Zenker’s diverticulum using CO2 laser. Otolaryngol Head Neck Surg 127:309–314
Keck T, Rozsasi A, Grün PM (2010) Surgical of hypopharyngeal diverticulum (Zenker’s diverticulum). Eur Arch Otorhinolaryngol 267:587–592
Kos MP, David EF, Mahieu HF (2009) Endoscopic carbon dioxide laser Zenker’s diverticulotomy revisited. Ann Otol Rhinol Laryngol 118:512–518
Hoffmann M, Scheunemann D, Rudert HH, Maune S (2003) Zenker’s diverticulotomy with the carbon dioxide laser: perioperative management and long-term results. Ann Otol Rhinol Laryngol 112:202–205
Skaug HP, Geirdal AO, Brøndbo K (2013) Laser diverticulotomy for Zenker’s diverticulum–does it improve quality of life? Eur Arch Otorhinolaryngol 270:2485–2490
Flikweert DC, van der Baan (1992) Endoscopic treatment of pharyngeal pouches: electrocoagulation vs carbon dioxide [CO2] laser. Clin Otolaryngol 17:122–124
Knegt PP, de Jong PC, van der Schans EJ (1984) Endoscopic laser surgery for hypopharyngeal diverticula—a preliminary report. Clin Otolaryngol 9:277–279
Chang CW, Burkey BB, Netterville JL, Courey MS, Garrett CG, Bayles SW (2004) Carbon dioxide laser endoscopic diverticulotomy versus open diverticulectomy for Zenker’s diverticulum. Laryngoscope 114:519–527
Miller FR, Bartley J, Otto RA (2006) The endoscopic management of Zenker diverticulum: cO2 laser versus endoscopic stapling. Laryngoscope 116:1608–1611
Chang CY, Payyapilli RJ, Scher RL (2003) Endoscopic stapler diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope 113:957–965
Brace M, Taylor SM, Trites JR, Bethune D, Attia E, Hart RD (2010) Endoscopic stapling versus external transcervical approach for the treatment of Zenker diverticulum. J Otolaryngol Head Neck Surg 39:102–106
Verhaegen VJ, Feuth T, van den Hoogen FJ, Marres HA, Takes RP (2011) Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple-assisted diverticulostomy to treat Zenker’s diverticulum. Head Neck 33:154–159
Wasserzug O, Zikk D, Raziel A, Cavel O, Fleece D, Szold A (2010) Endoscopically stapled diverticulostomy for Zenker’s diverticulum: results of a multidisciplinary team approach. Surg Endosc 24:637–641
Leong SC, Wilkie MD, Webb CJ (2012) Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom. Eur Arch Otorhinolaryngol 269:1877–1884
Whited C, Lee WT, Scher R (2012) Evaluation of endoscopic harmonic diverticulostomy. Laryngoscope 122:1297–1300
Nielsen HU, Trolle W, Rubek N, Homøe P (2014) New Technique using Ligasure™ for Endoscopic mucomyotomy of Zenker’s diverticulum. Laryngoscope 124:2039–2042
Papaspyrou G, Ferlito A, Silver CE, Werner JA, Genden E, Sesterhenn AM (2011) Extracervical approaches to endoscopic thyroid surgery. Surg Endosc 25:995–1003
Dohlman G, Mattson O (1960) The endoscopic operation for hypopharyngeal diverticula: a roentgencinematographic study. AMA Arch Otolaryngol 71:744–752
Bloom JD, Bleier BS, Mirza N, Chalian AA, Thaler ER (2010) Factors predicting endoscopic exposure of Zenker’s diverticulum. Ann Otol Rhinol Laryngol 119:736–741
Seth R, Rajasekaran K, Lee WT, Lorenz RR, Wood BG, Kominsky A, Scharpf J (2014) Patient reported outcomes in endoscopic and open transcervical treatment for Zenker’s diverticulum. Laryngoscope 124:119–125
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Papaspyrou, G., Schick, B., Papaspyrou, S. et al. Laser surgery for Zenker’s diverticulum: European combined study. Eur Arch Otorhinolaryngol 273, 183–188 (2016). https://doi.org/10.1007/s00405-014-3486-4
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DOI: https://doi.org/10.1007/s00405-014-3486-4