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Postendoscopic Zenker esophagodiverticulostomy leaks associated with a specific stapler cartridge
William J Richtsmeier1, Jose Raul Monzon
1Bassett Healthcare, One Atwell Road, Cooperstown, NY 13326. william.richtsmeier@bassett.org
Objective:
To determine the cause of postoperative leaks in 2 patients with Zenker diverticula treated with endoscopic staple-assisted esophagodiverticulostomy.
Design:
Medical chart review and simulated surgery.
Setting:
Teaching hospital.
Patients And Methods:
Two case reports of postoperative leaks in patients treated with endoscopic staple-assisted esophagodiverticulostomy and experimental simulated surgery to investigate the possible cause of this complication. Use of a TR45B, 3.5-mm cartridge for an Endopath ETS Flex45 Endoscopic Articulation Linear Cutter stapler was associated with complications, whereas use of a TR45W, 2.5-mm cartridge in the same stapler was not.
Results:
In a simulated surgery model, the 3.5-mm cartridge staple line leaked from the incision apex with pressure of less than 20 cm H(2)O, whereas the apex remained dry when using the 2.5-mm cartridge. When pressure was increased to 30 cm H(2)O, the staple line of the 2.5-mm cartridge had diffuse weeping of fluid but no focal, apical leak.
Conclusions:
Endoscopic staple-assisted esophagodiverticulostomy continues to be a relatively safe procedure; however, to provide maximum safety at the apex, the surgeon needs to be aware of stapler cartridge differences.
