Endoscopic laser vs open approach for cricopharyngeal myotomy

Abstract

Objectives: Cricopharyngeal myotomy (CPM) can be highly successful in treating the properly selected dysphagia patient. Our objective was to illustrate the safety and efficacy of the endoscopic laser (EL) approach for CPM compared to the traditional open, transcervical approach. Methods: Our patient database was searched for all surgical reports involving a CPM. Patients who had undergone concurrent head and neck operations or a Zenker’s diverticulotomy were excluded. The medical records of 22 eligible patients were reviewed to detail symptoms, diagnostic test results, perioperative course, and functional outcomes. Results: Of the 22 patients reviewed, the EL technique was used in 14, and an open approach in 8. The most common indication for CPM was a cricopharyngeal bar (7/22). The mean hospital stay was 1.2 days in the EL group (range, 0–3) and 4.4 (range, 1–25) in the Open group. The mean operating time was 37 minutes (range, 10–95 minutes) in the EL group and 131 minutes (range, 102–175) in the Open group. The average change in the FOSS (Functional Outcome Swallowing Scale) was 1.6 in the EL group and 1.3 in the Open group, indicating symptomatic improvement in both groups. There were no significant complications in the EL group, while 1 patient in the Open group had a pharyngocutaneous fistula. Conclusions: The EL technique is at least as effective as the traditional open technique for CPM to improve dysphagia symptoms in the properly selected patient. Both operating time and hospital stay were shorter in the EL group and no major complications occurred.