Preliminary experience by a thoracic service with endoscopic transoral stapling of cervical (Zenker's) diverticulum

Recently endoscopic transoral stapling (ES) of cervical (Zenker's) diverticulum (ZD) has been reported. In a 10-year retrospective review, we identified 47 patients undergoing ES or open surgery (OS) for ZD. ES was attempted in 28 patients and OS in 19. Using an intention to treat analysis, outcomes examined included operative time, length of stay, and dysphagia severity using a scale from 1 (no dysphagia) to 5 (severe dysphagia). ES was completed in 24/28 patients with four conversions to OS. The mean age was 75 years for the ES group and 70 years for the OS group (p = 0.079). Mean operative time (1.57 versus 2.35 h.) was less (p < 0.03) in the ES group. Length of stay (2.12 versus 2.44 days) was shorter for ES but not significant (P = 0.49). Mean follow up was 17 (1-103) months for both groups. Dysphagia scores were comparable between the two groups preoperatively (2.78 ES versus 2.79 OS; p = 0.98) and improved significantly (p = 0.001) to 1.1 after ES and 1.0 after OS. The time to oral intake was 1.38 days in the ES group and 1.29 days in the OS group (p = 0.80). We conclude that ES is feasible and can be performed with shorter operative times and comparable short-term results to OS.