title: Open staple diverticulectomy for a large recurrent Zenker's diverticulum: still a valid procedure.
abstract: OBJECTIVE
  We demonstrate indications for external mechanical stapler diverticulectomy in the modern era of endoscopic treatment. We review treatment of a large diverticulum and discuss considerations that should be made in deciding on the type of surgical treatment.
  
  
  METHODS
  The index case was in a 75-year-old man who had undergone open cricopharyngeal myotomy with diverticulopexy 35 years earlier. He presented with 25 years of recurrent symptoms. A swallow study showed a 6.5 x 5.0-cm diverticulum. The diverticulum was deemed too large for standard endoscopic myotomy, so diverticulectomy was performed with a stapler.
  
  
  RESULTS
  The patient was discharged on postoperative day 3 without complications. A swallow study on postoperative day 5 demonstrated no diverticulum or extravasation of barium. The patient resumed a normal diet with resolution of dysphagia. Two additional patients with large Zenker's diverticula that were managed similarly are also discussed.
  
  
  CONCLUSIONS
  Although endoscopic laser cricopharyngeal myotomy and stapler diverticulostomy have become standard treatments for Zenker's diverticulum, this case of a large recurrent diverticulum illustrates a situation in which older techniques may be preferred. Use of the mechanical stapler allowed for a shorter surgery time than traditional suture techniques, and the potential for an earlier return to a normal diet.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
authors.forename: Andy M
authors.initials: AM
authors.lastname: Courson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
authors.forename: April M
authors.initials: AM
authors.lastname: Landry
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Lott
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hinni
mesh_terms: D000368:Aged; D003413:Cricoid Cartilage / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010609:Pharyngeal Muscles / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D016672:Zenker Diverticulum / Q000175:diagnosis / Q000601:surgery*