title: Laser versus stapler: outcomes in endoscopic repair of Zenker diverticulum.
abstract: OBJECTIVE
  To analyze a single surgeon's experience with endoscopic CO(2)  laser and stapler repair of Zenker diverticulum (ZD) by comparing dysphagia and regurgitation outcomes.
  
  
  METHODS
  Retrospective chart review of 148 patient charts.
  
  
  METHODS
  Medical records of all patients receiving endoscopic repair of ZD with either CO(2)  laser (61 patients) or stapler (67 patients) were reviewed. Additional data included demographics (age and sex), size (cm), preoperative and postoperative symptoms, need for revision, and complications. Symptoms of dysphagia were graded based on a modified Functional Oral Intake Scale 1 to 4 scale (1 = normal intake; 4 = severely limited/G-tube dependent). Regurgitation was also graded on a 1 to 4 scale (1 = no regurgitation; 4 = aspiration events).
  
  
  RESULTS
  We noted no difference in patient age or defect size (laser, 3.26 cm; stapler, 3.53 cm; P .135). Significant differences were noted in return trips to the operating room for failed procedures (laser, 0; stapler, 7; P = .009), length of stay (laser, 3.19 days; stapler, 1.29 days; P < .001), time to oral intake (laser, 3.01 days; stapler, 1.22 days; P < .001). Significant improvement occurred in laser and staple patient symptom scales following surgery (P < .001). Laser dysphagia and regurgitation scores showed greater improvement when compared to stapler scores (P < .001).
  
  
  CONCLUSIONS
  Endoscopic CO(2)  laser and staple methods are effective in treating ZD. The laser can have greater efficacy and result in lower recurrence rates. Both methods are analyzed and compared.
authors.affiliation: Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA. stewart.adam@yale.edu
authors.forename: Stewart I
authors.initials: SI
authors.lastname: Adam
authors.forename: Boris
authors.initials: B
authors.lastname: Paskhover
authors.forename: Clarence T
authors.initials: CT
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D013537:Sutures; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000175:diagnosis* / Q000601:surgery*