title: Long-term outcome and quality of life after transoral stapling for Zenker diverticulum.
abstract: OBJECTIVE
  To investigate long-term results and quality of life after transoral stapling of Zenker diverticulum.
  
  
  METHODS
  The data of all patients admitted to our institution for the surgical treatment of Zenker diverticulum were entered into a prospective database. Demographics, symptoms, intraoperative and postoperative data, morbidity, time to oral feeding, and length of hospital stay were recorded. All patients underwent upper gastrointestinal endoscopy and a barium swallow study to measure the length of the diverticulum from the apex of the septum to the bottom of the pouch. Transoral stapling was performed using a Weerda diverticuloscope under general anesthesia. Over time, the technique was modified by applying traction sutures to ease engagement of the common septum inside the stapler jaws. Perioperative variables, symptoms, long-term outcome, and quality of life were analyzed. The operation was considered successful if the patient reported complete remission (grade 1) or marked improvement (grade 2) of dysphagia, regurgitation, and respiratory symptoms. Statistical analysis was performed using Statistical Package for Social Science (SPSS, Version 15, SPSS, Inc., Chicago, IL).
  
  
  RESULTS
  Between 2001 and 2013, the transoral approach was successfully completed in 100 patients with a median age of 75 years. Patients with a larger (≥3 cm) diverticulum were older than those with a smaller pouch (P<0.038). Complications occurred in 4% of the patients but there was no mortality. A statistically significant improvement of dysphagia and regurgitation scores (P<0.001) was recorded over a median follow-up of 63 mo. Similarly, a significant decrease in the median number of pneumonia episodes per year (P<0.001) was recorded after surgery. The overall long-term success rate of the procedure was 76%. The success rate of the operation was greater in patients of 70 years of age or older compared to younger individuals (P=0.038). Use of traction sutures on the septum was associated with an improved success rate compared with the standard procedure (P=0.04). All items of the health related quality of life questionnaire were significantly higher compared to baseline (P<0.05).
  
  
  CONCLUSIONS
  Transoral stapling is safe and effective. The operation significantly improves patients' quality of life. It appears that elderly patients with large diverticula significantly benefit from the procedure and that the modified surgical technique including traction sutures can further improve the success rate.
authors: Luigi Bonavina, Alberto Aiolfi, Federica Scolari, Davide Bona, Andrea Lovece, Emanuele Asti, IRCCS Policlinico San Donato, Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milano, Italy.
authors: Luigi
authors: L
authors: Bonavina
authors: Luigi Bonavina, Alberto Aiolfi, Federica Scolari, Davide Bona, Andrea Lovece, Emanuele Asti, IRCCS Policlinico San Donato, Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milano, Italy.
authors: Alberto
authors: A
authors: Aiolfi
authors: Luigi Bonavina, Alberto Aiolfi, Federica Scolari, Davide Bona, Andrea Lovece, Emanuele Asti, IRCCS Policlinico San Donato, Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milano, Italy.
authors: Federica
authors: F
authors: Scolari
authors: Luigi Bonavina, Alberto Aiolfi, Federica Scolari, Davide Bona, Andrea Lovece, Emanuele Asti, IRCCS Policlinico San Donato, Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milano, Italy.
authors: Davide
authors: D
authors: Bona
authors: Luigi Bonavina, Alberto Aiolfi, Federica Scolari, Davide Bona, Andrea Lovece, Emanuele Asti, IRCCS Policlinico San Donato, Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milano, Italy.
authors: Andrea
authors: A
authors: Lovece
authors: Luigi Bonavina, Alberto Aiolfi, Federica Scolari, Davide Bona, Andrea Lovece, Emanuele Asti, IRCCS Policlinico San Donato, Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milano, Italy.
authors: Emanuele
authors: E
authors: Asti
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D016672:Zenker Diverticulum / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*
keywords: Aspiration pneumonia; Cricopharyngeal myotomy; Diverticulectomy; Dysphagia; Flexible endoscopy; Short-form health survey questionnaire; Transoral stapling; Zenker diverticulum
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