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Original Article
February 2002

Postendoscopic Zenker Esophagodiverticulostomy Leaks Associated With a Specific Stapler Cartridge

Author Affiliations

From Bassett Healthcare, Cooperstown, NY.

Arch Otolaryngol Head Neck Surg. 2002;128(2):137-140. doi:10.1001/archotol.128.2.137

Objective  To determine the cause of postoperative leaks in 2 patients with Zenker diverticula treated with endoscopic staple-assisted esophagodiverticulostomy.

Design  Medical chart review and simulated surgery.

Setting  Teaching hospital.

Patients and Methods  Two case reports of postoperative leaks in patients treated with endoscopic staple-assisted esophagodiverticulostomy and experimental simulated surgery to investigate the possible cause of this complication. Use of a TR45B, 3.5-mm cartridge for an Endopath ETS Flex45 Endoscopic Articulation Linear Cutter stapler was associated with complications, whereas use of a TR45W, 2.5-mm cartridge in the same stapler was not.

Results  In a simulated surgery model, the 3.5-mm cartridge staple line leaked from the incision apex with pressure of less than 20 cm H2O, whereas the apex remained dry when using the 2.5-mm cartridge. When pressure was increased to 30 cm H2O, the staple line of the 2.5-mm cartridge had diffuse weeping of fluid but no focal, apical leak.

Conclusions  Endoscopic staple-assisted esophagodiverticulostomy continues to be a relatively safe procedure; however, to provide maximum safety at the apex, the surgeon needs to be aware of stapler cartridge differences.