• J. Thorac. Cardiovasc. Surg. · Jun 2022

    Transoral endoscopic repair of Zenker diverticulum by a thoracic surgical service.

    • Ryan M Levy, James D Luketich, Daniel Brynien, Chinenyenwa Mpamaugo, Manisha R Shende, William E Gooding, Arjun Pennathur, and University of Pittsburgh/UPMC Zenker's Diverticulum Study Group.
    • Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pa.
    • J. Thorac. Cardiovasc. Surg. 2022 Jun 1; 163 (6): 1965-1974.e1.

    ObjectiveZenker diverticulum (ZD), a pulsion diverticulum of the esophagus, has been traditionally managed with an open surgical approach, but endoscopic transoral stapling has been reported with increasing frequency. The objective of this study was to evaluate the results of endoscopic repair of ZD by a thoracic surgery service.MethodsWe conducted a retrospective review of patients who underwent transoral stapling repair of ZD at our institution by the thoracic surgery service. We evaluated perioperative outcomes including dysphagia (1, no dysphagia to 5, unable to swallow saliva) and failure of repair requiring surgical intervention.ResultsA total of 151 patients (median age, 78 years; 75 men, 76 women) underwent evaluation for endoscopic repair of ZD. Endoscopic stapled repair of the ZD was completed in 135. Sixteen patients underwent conversion to open repair. The perioperative mortality was 0.6% (1 patient). The median hospital stay was 2 days (range, 0-18 days). Complications occurred in 5 patients who underwent endoscopic repair. The mean preoperative dysphagia score was 2.8 and improved to 1.2 during follow-up (median, 16 months; P < .001). During further follow-up (median, 52 months), 8 patients (5.3%) had failure of the endoscopic repair requiring open surgery (n = 5) or redo transoral stapling (n = 3).ConclusionsEndoscopic stapling repair of ZD can be performed safely with good results in experienced centers by thoracic surgeons with significant esophageal experience. Long-term follow-up is required to evaluate the durability of endoscopic repair of ZD.Copyright © 2021. Published by Elsevier Inc.

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