Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1167
Peer-review started: March 24, 2014
First decision: April 28, 2014
Revised: May 2, 2014
Accepted: November 8, 2014
Article in press: November 11, 2014
Published online: January 28, 2015
AIM: To investigate long-term results and quality of life after transoral stapling of Zenker diverticulum.
METHODS: The data of all patients admitted to our institution for the surgical treatment of Zenker diverticulum were entered into a prospective database. Demographics, symptoms, intraoperative and postoperative data, morbidity, time to oral feeding, and length of hospital stay were recorded. All patients underwent upper gastrointestinal endoscopy and a barium swallow study to measure the length of the diverticulum from the apex of the septum to the bottom of the pouch. Transoral stapling was performed using a Weerda diverticuloscope under general anesthesia. Over time, the technique was modified by applying traction sutures to ease engagement of the common septum inside the stapler jaws. Perioperative variables, symptoms, long-term outcome, and quality of life were analyzed. The operation was considered successful if the patient reported complete remission (grade 1) or marked improvement (grade 2) of dysphagia, regurgitation, and respiratory symptoms. Statistical analysis was performed using Statistical Package for Social Science (SPSS, Version 15, SPSS, Inc., Chicago, IL).
RESULTS: Between 2001 and 2013, the transoral approach was successfully completed in 100 patients with a median age of 75 years. Patients with a larger (≥ 3 cm) diverticulum were older than those with a smaller pouch (P < 0.038). Complications occurred in 4% of the patients but there was no mortality. A statistically significant improvement of dysphagia and regurgitation scores (P < 0.001) was recorded over a median follow-up of 63 mo. Similarly, a significant decrease in the median number of pneumonia episodes per year (P < 0.001) was recorded after surgery. The overall long-term success rate of the procedure was 76%. The success rate of the operation was greater in patients of 70 years of age or older compared to younger individuals (P = 0.038). Use of traction sutures on the septum was associated with an improved success rate compared with the standard procedure (P = 0.04). All items of the health related quality of life questionnaire were significantly higher compared to baseline (P < 0.05).
CONCLUSION: Transoral stapling is safe and effective. The operation significantly improves patients’ quality of life. It appears that elderly patients with large diverticula significantly benefit from the procedure and that the modified surgical technique including traction sutures can further improve the success rate.
Core tip: Transoral stapling was introduced 20 years ago as an alternative to standard open cricopharyngeal myotomy and diverticulectomy for the treatment of Zenker diverticulum. Long-term results after this operation have seldom been reported and quality of life data are lacking. Between 2001 and 2013, 100 patients underwent transoral stapling under general anesthesia. Perioperative variables, symptoms, long-term outcome, and quality of life were analyzed. The median follow-up was longer than 5 years. The success rate of the operation was significantly greater in patients of 70 years of age or older compared to younger individuals. All items of the health related quality of life questionnaire were significantly higher compared to baseline.