RESULTS AND EXPERIENCE WITH THE CARBON-DIOXIDE LASER FOR MICROENDOSCOPIC SURGERY OF HYPOPHARYNGEAL (ZENKERS) DIVERTICULA

Since 1984 at the Department of Otorhinolaryngology, Head and Neck Sur gery, University of Kiel, 34 patients with hypopharyngeal diverticula have been operated microendoscopically using the CO2 laser. Results an d complications of this technique were compared to a group of patients in whom standard (nonlaser) diverticulotomy was carried out from 1976 to 1993. Ninety per cent of the patients treated endoscopically with laser surgery have not had complaints and the rate of postoperative co mplications has been low. Three patients developed pharyngeal stenoses while one case incurred a mediastinitis. Intraoperative bleeding was not observed. In comparison to the microendoscopic procedure serious c omplications were more frequently observed in patients treated with th e standard diverticulotomy. In eight of these cases paralysis of the r ecurrent laryngeal nerve occurred. A mediastinotomy was performed in a nother three patients because of mediastinitis. In two cases stenosis occurred after surgery and one patient developed a fistula. Endoscopic diverticulotomy utilizing a CO2 laser was found to be an excellent tr eatment for Zenker's diverticulum because of the good functional resul ts achieved and low complication rate. The procedure was easy to perfo rm because of the short duration and could be repeated frequently with out significant additional risks.