ABSTRACT
OBJECTIVE: Very few reports investigated techniques of closure of the basal wound area to reduce severe complications like mediastinitis after endoscopic laser diverticulotomy. In this study, we report our experiences after routine use of a collagen-fibrin sealant patch for basal wound covering after laser diverticulotomy in consideration of postoperative complications and recurrence rates. PATIENTS AND METHODS: This retrospective study was conducted in a tertiary referral center and university hospital. Endoscopic laser diverticulotomies performed in our hospital between January 2006 and July 2018 were included. After complete transection of the laser septum of the diverticulum, we placed a collagen-fibrin patch onto the basal wound area to cover the opening to the mediastinum. Patient records were evaluated to assess the occurrence of perioperative complications, and the data were compared with those reported in the literature. RESULTS: A total of 127 endoscopic laser diverticulotomies were performed in 109 patients (71 men, 38 women) suffering from Zenker's diverticulum. Morality rate was 0%, in particular no mediastinitis was observed. Mediastinal emphysema was observed in two patients (1.6%), and temporary or persistent recurrent nerve palsy in one patient (0.8%) each. The mean follow-up period was 71.6±5.16 months. Recurrent symptomatic diverticulum was observed in 19.3% of the patients. CONCLUSIONS: These findings suggest that use of a collagen-fibrin sealant patch in endoscopic laser diverticulotomy may contribute to the safety of endoscopic controlled laser diverticulotomy without comprising the success rates.
Subject(s)
Collagen/pharmacology , Fibrin Tissue Adhesive/pharmacology , Wound Healing/drug effects , Zenker Diverticulum/drug therapy , Aged , Aged, 80 and over , Esophagoscopy , Female , Humans , Laser Therapy , Lasers , Male , Middle Aged , Postoperative Complications/drug therapy , Postoperative Complications/surgery , Retrospective Studies , Treatment Outcome , Zenker Diverticulum/surgeryABSTRACT
The standard treatment for Zenker's diverticulum (ZD) is surgical, but transendoscopic section of the diverticular spur has also been performed with good results. We treated two patients with the injection of 300-350 IU of botulinum toxin type A (Dysport) into the diverticular spur. Both patients were dysphagic because of a large ZD. A few hours after the treatment, the patients were able to return to a normal, nonrestricted diet. They remain symptom-free 12 and 3 months later, respectively. No complications have been observed. As a result of its ease of application and efficacy, this treatment can be recommended for patients who are unable to undergo the surgical operations; it can be considered a valid alternative to the other endoscopic procedures.