Comparison of two endoscopic surgical methods for a safe therapy of Zenker's diverticulum.

Background: A mediastinitis or intraoperative bleeding are the most feared complications of the transoral laser assisted diverticulotomy of Zenker's d iverticulum. To reduce these complications we developed a new endoscopic su rgical technique and compared the results of this new method with the resul ts of patients who we treated earlier. Patients and Methods: At the departm ent of Otorhinolaryngology, Head and Neck Surgery, University of Luebeck 68 patients suffering from a hypopharyngeal diverticulum have been treated si nce 1987. In 64 patients we performed an endoscopic diverticulotomy using a CO2-Laser and the Weerda distending diverticuloscope. Four of the Zenker's diverticulua had to be removed by an external approach. From 1987 to 1994 a five millimeter bar between pouch and hypopharynx after diverticulotomy w as left and sealed with fibrin glue in the first 38 patients. From 1995 to 1999 the spur of the hypopharyngeal pouch of the other 26 patients was comp letely separated. Afterwards we sutured the mucosa between the pouch and th e hypopharynx to close the opened mediastinal space and sealed the former s pur with fibrin glue. Results: Comparing both endoscopic methods we had to observe concerning our first method one mediastinitis, a rise of body tempe rature in 29 patients (76%) and we had to perform a revision diverticulotom y in three patients (8%). Our modified technique didn't cause any mediastin itis, a rise of body temperature did only occur in five patients (18%) and no patient had to undergo revision surgery. Conclusions: The transoral comp lete separation of the spur of the hypopharyngeal pouch with suturing the m ucosa of the pouch and the hypopharynx causes good functional results and m eans a further reduction of complications and a further improvement of the endoscopic diverticulotomy. Our new instruments (Fa. K. Storz, Tuttlingen) will be demonstrated.