672 Endoscopic Laser Pharyngeal Pouch Surgery: Is It Safe?. (19th August 2022)

• Record Type: Journal Article
• Authors: Dhar, P; Maweni, R; Kucheria, A; Nair, D; Nagala, S; Corbridge, R
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 6
• Publication Date: 2022-08-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac269.194
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aim: Zenker diverticulum can cause significant dysphagia and surgery is the definitive management. NICE guidelines describe inadequate evidence on laser cricopharyngeal myotomy (CPM). This study aimed to assess the safety and efficacy of carbon dioxide laser and stapling CPM to treat Zenker diverticulum. Method: Retrospective data was collected from patients who underwent endoscopic CPM at the Royal Berkshire Hospital between 2011 and 2021. Two cohorts were assigned: endoscopic laser (EL) or endoscopic stapling (ES). Primary outcomes evaluated safety. These were surgical complication rates, duration of inpatient stay, readmissions, barium swallow leak and considered case complexity (revision cases). The secondary outcomes, persistence or recurrence of symptoms evaluated efficacy. Results: One-hundred and eight patients (mean [range] age 75 [38 – 95] yr, 71 (66%) men, 23 (21%) revision surgeries) underwent CPM. The EL (n = 76) cohort had two (2.63%) surgical complications (mucosal tear requiring no repair, mediastinitis from an oesophageal leak). The ES (n = 32) cohort had one (3.13%) surgical complication (mucosal tear requiring suture repair). The average duration of inpatient stay was 3.61 and 1.53 days for the EL and ES cohorts respectively. 65 patients (60%) underwent a post-operative barium swallow of which 2 (0.03%) patients, both from the EL cohort, had a leak. There were no readmissions. A chi-square test of independence showed no significant association between type of surgery and persistence [X2 (1) = 0.169, p = .681] or recurrence of symptoms [X2 (1) = 0.443, p = .506] Conclusions: Treatment of pharyngeal pouches with endoscopic laser CPM is safe and efficacious.