[Measures for reducing the rate of complications in endoscopic surgery of Zenker's diverticulum]

In the treatment of the pharyngeal pouch diverticulectomy and endoscopic diverticulotomy are generally accepted. The latter can lead to severe bleeding and mediastinitis. --Therefore the authors have extended the preoperative diagnostic procedure to include a DSA of the aortic arch. The simultaneous contrast filling of the pouch enables the exact position of the blood vessels relative to the bar to be established. --With the spreadable diverticuloscope developed by the authors, the use of a CO2 laser and an operating microscope, optimum endoscopic working conditions are assured. Postoperative sealing of the wound margin with fibrin reduces the likelihood of postoperative bleeding and mediastinitis, the risk of which have been further reduced by antibiotic prophylaxis and tube feeding for eight days. During and after the treatment of ten patients not a single complication has arisen.