title: Postendoscopic Zenker esophagodiverticulostomy leaks associated with a specific stapler cartridge.
abstract: OBJECTIVE
  To determine the cause of postoperative leaks in 2 patients with Zenker diverticula treated with endoscopic staple-assisted esophagodiverticulostomy.
  
  
  METHODS
  Medical chart review and simulated surgery.
  
  
  METHODS
  Teaching hospital.
  
  
  METHODS
  Two case reports of postoperative leaks in patients treated with endoscopic staple-assisted esophagodiverticulostomy and experimental simulated surgery to investigate the possible cause of this complication. Use of a TR45B, 3.5-mm cartridge for an Endopath ETS Flex45 Endoscopic Articulation Linear Cutter stapler was associated with complications, whereas use of a TR45W, 2.5-mm cartridge in the same stapler was not.
  
  
  RESULTS
  In a simulated surgery model, the 3.5-mm cartridge staple line leaked from the incision apex with pressure of less than 20 cm H(2)O, whereas the apex remained dry when using the 2.5-mm cartridge. When pressure was increased to 30 cm H(2)O, the staple line of the 2.5-mm cartridge had diffuse weeping of fluid but no focal, apical leak.
  
  
  CONCLUSIONS
  Endoscopic staple-assisted esophagodiverticulostomy continues to be a relatively safe procedure; however, to provide maximum safety at the apex, the surgeon needs to be aware of stapler cartridge differences.
authors.affiliation: Bassett Healthcare, One Atwell Road, Cooperstown, NY 13326. william.richtsmeier@bassett.org
authors.forename: William J
authors.initials: WJ
authors.lastname: Richtsmeier
authors.forename: Jose Raul
authors.initials: JR
authors.lastname: Monzon
mesh_terms: D000368:Aged; D004868:Equipment Failure; D004945:Esophagoscopy / Q000009:adverse effects*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005932:Gloves, Surgical; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011183:Postoperative Complications; D013528:Surgical Staplers / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016672:Zenker Diverticulum / Q000601:surgery*