Endoscopic stapled diverticulotomy: treatment of choice for Zenker's diverticulum.

OBJECTIVE: To evaluate the efficacy and safety of endoscopic stapled diverticulotomy in the treatment of patients with Zenker's diverticulum. STUDY DESIGN: Cohort study. METHODS: Fourteen elderly patients (11 men and 3 women) with Zenker's diverticulum were evaluated in a community hospital setting from July 1996 to November 1999. Before surgery patients had significant dysphagia, regurgitation, cough, or aspiration pneumonia. The common septum between the diverticulum and cervical esophagus was visualized with a Weerda diverticuloscope. While using videoendoscopic monitoring, the septum was divided and the edges simultaneously sealed with a linear endoscopic stapler. Average operative time was 31 minutes. RESULTS: The operation was successfully performed in 11 of 14 patients. In the three unsuccessful cases, one patient's pouch was too small to staple and the other two patients had a septum that was difficult to visualize with the diverticuloscope. There was no significant postoperative morbidity or mortality. Patients started a liquid diet on the first postoperative day and resumed a soft diet a week later. They were usually discharged on the first postoperative day. Most patients reported significant improvement with resolution of dysphagia and regurgitation. CONCLUSIONS: Compared with the traditional open technique, the endoscopic stapled diverticulotomy technique is safe, quick, and effective and requires a shorter length of stay in the hospital. Therefore it has become our treatment of choice for elderly, high-risk patients with a large (>2 cm) hypopharyngeal (Zenker's) diverticulum.

Surgical anatomy of the scapular spine in the trapezius-osteomuscular flap.

Measurements of the spine of the scapula in relationship to the trapezius-osteomuscular flap were made in a series of cadavers. These measurements enable estimation of the amount of available bone present and give the reconstructive surgeon a series of guidelines for using the trapezius-osteomuscular flap in correcting mandibular defects. A related phase of this investigation was the development of a roentgenographic technique using the 30 degree cephalic view of the shoulder for preoperative assessment of the spine of the scapula.