title: Endoscopic or external approach revision surgery for pharyngeal pouch following primary endoscopic stapling: which is the favoured approach?
abstract: This study aimed to assess outcomes of revision endoscopic stapling and external excision of pharyngeal pouch. A 5-year prospective study was performed on all patients requiring revision pouch surgery following primary endoscopic stapling. Data were collected retrospectively. Eighteen patients underwent revision pouch surgery. In seven patients, pouch size was down-graded from 3 to 2, and these were stapled endoscopically. Two leaks resulted. Eleven patients with grade 1 or 3 pouches underwent external excision of pouch, with no post-operative complications. As per results external excision of pouch is safe for grade 1 and 3 pouches. It avoids risking redundant mucosa and recurrence of symptoms which can complicate stapling and enables a myotomy to be performed to reduce cricopharyngeal hypertonicity. The highest predictable success is with grade 2 pouches, whose size is amenable to adequate endoscopic stapling. However, the "staple over staple" effect of revision stapling leads to unpredictable fibrosis, which can contribute to risk of perforation.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. malcolm_buchanan123@hotmail.com
authors.forename: Malcolm A
authors.initials: MA
authors.lastname: Buchanan
authors.forename: Faruque
authors.initials: F
authors.lastname: Riffat
authors.forename: Ali K
authors.initials: AK
authors.lastname: Mahrous
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fish
authors.forename: Piyush
authors.initials: P
authors.lastname: Jani
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D017792:Surgical Stapling; D016672:Zenker Diverticulum / Q000150:complications / Q000601:surgery*