Endoscopic or external approach revision surgery for pharyngeal pouch following primary endoscopic stapling: which is th
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HEAD AND NECK
Endoscopic or external approach revision surgery for pharyngeal pouch following primary endoscopic stapling: which is the favoured approach? Malcolm A. Buchanan • Faruque Riffat • Ali K. Mahrous • Brian M. Fish • Piyush Jani
Received: 30 June 2012 / Accepted: 7 September 2012 / Published online: 27 September 2012 Ó Springer-Verlag 2012
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.
procedure for the treatment of pharyngeal pouch, due to its brief operating time, low risk of morbidity, quick resumption of oral intake and short post-operative stay [3]. This makes it a particularly attractive procedure for elderly patients, in whom pouches are more common (2/100,000/ year in UK) [4]. Despite the risk of recurrence, the incidence of persistent or recurrent dysphagia following this procedure is low (\ 6 %) [5], and hence the reported incidence of revision procedures is also small. Of studies in the literature pertaining to revision pouch surgery, the majority of procedures are performed endoscopically, and very few external procedures are described [5–8]. The current study is a sequel to our previous study on the UK’s largest series of primary endoscopic pharyngeal pouch staplings, in which the revision surgery rate was 18 % [9]. Our institution is a regional referral centre for revision pharyngeal pouch surgery, and this study examines our experience over a 5-year period with this procedure, utilising both endoscopic and external approaches.
Keywords Pharyngeal pouch Revision surgery Endoscopic stapling External excision
Materials and methods Data collection
Introduction Endoscopic stapling of pharyngeal pouch was first reported in 1993 [1, 2]. It has since become a well-accepted
M. A. Buchanan (&) F. Riffat A. K. Mahrous B. M. Fish P. Jani Department of Otorhinolaryngology and Head & Neck Surgery, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK e-mail: [email protected]
A prospective study was performed over the 5-year period from 2004 to 2009 on all
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