title: Carbon dioxide laser endoscopic diverticulotomy versus open diverticulectomy for Zenker's diverticulum.
abstract: OBJECTIVE
  To compare open and CO2 laser-assisted endoscopic surgical management of Zenker's diverticulum.
  
  
  METHODS
  A retrospective review of 49 consecutive surgically treated patients with Zenker's diverticulum was conducted.
  
  
  METHODS
  Patients' records were reviewed and analyzed for patient age and sex, size of diverticulum, incision time (time recorded from start of incision to surgical completion of case), length of hospital stay, complications, and follow-up management. A postoperative questionnaire inquiring about swallow function was conducted by mail or telephone. Swallow function was assessed on a four-point scale.
  
  
  RESULTS
  Various procedures performed included endoscopic CO2 laser-assisted diverticulotomy (n = 24) and open diverticulectomy with cricopharyngeal myotomy (n = 28). The average incision time of laser endoscopic cases (47 min) was significantly shorter (P <.001) than that of open diverticulectomy cases (170 min). Length of hospital stay did not significantly vary between the two groups. Five patients (21%) initially treated with laser endoscopic diverticulotomy demonstrated symptomatic persistent Zenker's diverticulum; three underwent repeat operation. No open cases required repeat operation. One endoscopic case was aborted secondary to esophageal injury from placement of the endoscope. Postoperative fever was seen in two (8%) endoscopic cases and four (14%) open approach cases. No major complications (recurrent laryngeal nerve paralysis, mediastinitis, or death) were encountered. More than 90% of respondents in each treatment group reported normal or near-normal swallow function.
  
  
  CONCLUSIONS
  Laser endoscopic management is a reasonable and safe method for surgical treatment of Zenker's diverticulum in comparison with the open technique. Employment of the endoscopic approach reduces operative time and the complexity of postoperative care. Practitioners should be aware that the endoscopic approach may result in a higher failure rate.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. david.chang@aya.yale.edu
authors.forename: C W David
authors.initials: CW
authors.lastname: Chang
authors.forename: Brian B
authors.initials: BB
authors.lastname: Burkey
authors.forename: James L
authors.initials: JL
authors.lastname: Netterville
authors.forename: Mark S
authors.initials: MS
authors.lastname: Courey
authors.forename: C Gaelyn
authors.initials: CG
authors.lastname: Garrett
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Bayles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*
chemical_list: D002245:Carbon Dioxide