Revision Endoscopic Stapler Zenker's Diverticulotomy

Abstract

Objectives: Endoscopic stapler Zenker’s diverticulotomy (ESD) has become a well-accepted treatment of Zenker’s diverticulum (ZD). A small percentage of ZDs may recur after ESD. We sought to evaluate the technical feasibility, safety, and effectiveness of revision endoscopic stapler diverticulotomy (RESD) for recurrent ZD. Methods: A retrospective case study conducted in Tel-Aviv Sourasky Medical Center. The records of all patients who underwent ESD between the years 2002 and 2013 were reviewed. The records of patients who underwent RESD were identified and screened for primary surgical history, symptoms of recurrent ZD, time to recurrence, intraoperative and postoperative RESD course, complications, and symptom resolution. Results: Eighty-nine ESD were performed. Twenty were RESD for recurrent ZD and 69 were primary ESD (PESD). Nine RESD were performed for recurrent ZD after open trans-cervical Zenker’s diverticulectomy, 10 ESRD were performed for recurrent ZD after ESD, and 1 initial surgical approach was unknown. Mean patient age at revision was 66.1 years and mean time from first operation for ZD to RESD was 4.7 years. Average ESRD surgery time and hospital stay were 21.4 minutes and 2.8 days, respectively. Endoscopic stapling of the ZD was achieved in 19 of 20 RESD. Relief of symptoms without recurrence was achieved after 18 RESD. Four RESD patients experienced minor postoperative complications. We found no significant differences between the RESD and PESD groups regarding age, operative time, technical feasibility, hospital stay, and complication rate ( P > .05). Conclusions: RESD for ZD is technically feasible, safe, and effective. Results compare to PESD.