Endoscopic stapler-assisted Zenker's diverticulotomy: which is the best operative facility?

Despite great changes in treatment for Zenker's diverticulum, endoscopic stapler-assisted diverticulotomy (ESD) has not yet been included on the lists of possible day-case procedures, and determining the best operative facility is still a matter of debate. The aim of this article was to evaluate the safety and feasibility of endoscopic treatment for patients with Zenker's diverticulum on a planned 24-hour-stay basis.

We retrospectively reviewed cases in which patients were admitted to and operated on at the Department of Airway Endoscopic Surgery of the Padua University Hospital over a 5-year period (January 2000 to December 2004).

We considered 106 consecutive ESDs performed on 86 patients (1.23 procedures/patient). All procedures were planned on a 24-hour-stay basis ("1-day surgery"). In no case was the endoscopic procedure aborted. The mean operative time was 14 minutes (range, 5-45 minutes). Neither perioperative mortality nor major complications occurred. Minor complications were noted in 3 cases (2.8%). The mean time taken to resume oral intake was 0.83 days (range, 0-1). The mean hospital stay was 1.06 days (range, 0-5). Ninety-nine patients (93.4%) were discharged within the 24 hours after surgery. In no case was readmission necessary.

We believe that ESD is a suitable operation for 1-day surgery. This facility, in fact, ensures the same outcome and safety conditions as with the inpatient procedure, making it possible to rationalize health resource management, reduce hospital costs, and improve patient comfort. In selected cases, ESD could be performed on an outpatient basis.