Treatment of Zenker's diverticulum with endoscopic laser diverticulotomy: Complication rates using a fibrin sealant patch (TachoSil®)

Introduction:

Endoscopic laser diverticulotomy is a well-accepted, minimally invasive surgical treatment of Zenker's diverticulum. The overall complication rate reported in literature is less than 5%, the failure rate is about 20%. Most frequent reported complication is mediastinal emphysema in 3%, the most severe complication is mediastinitis in 1 – 1.5%. This study was designed to figure out, if the use of a fibrin sealant patch can further reduce complication rate regarding mediastinitis and mediastinal emphysema in endoscopic approaches.

Methods:

We systematically reviewed all endoscopic laser diverticulotomies performed in our hospital between January 2006 and December 2016. At the end of every procedure, a TachoSil® patch was used to seal the wound. All perioperative complications were noted and compared to complication rates reported in literature.

Results:

In the examined period 110 endoscopic laser diverticulotomies were performed in 93 patients (62 male/31 female) suffering from pharyngeal pouch. Bleeding occurred in one patient (0.9%), fistula in 0 patients, recurrent nerve palsy in one patient (0.9%), mediastinal emphysema in 2 patients (1.8%), mediastinitis in 0 patients, failure in 24 patients (21.8%). Compared to complication rates reported in literature, this is a lower rate of mediastinal emphysema and mediastinitis.

Conclusions:

Our data suggests that routine use of a fibrin sealant patch in endoscopic laser diverticulotomy can help to prevent severe complications.

Publication History

Publication Date:
18 April 2018 (online)