32 years of experience with CO 2 -LASER-assisted treatment for Zenker's Diverticulum - an update of 227 patients treated in Kiel.

OBJECTIVES: To underline the value of the microendoscopic CO2 -LASER-assisted treatment (MEDCO2 ) for Zenker's diverticulum by investigating a large patient cohort treated in a single medical centre.

DESIGN: Retrospective cohort study of consecutive patients.

SETTING: Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, Germany.

PARTICIPANTS: A total of 227 patients with Zenker's diverticulum were treated by MEDCO2 , and the results were compared with those reported in the literature for the open transcervical approach (OTA) and the endoscopic staple-assisted oesophagodiverticulostomy (ESED).

OUTCOME MEASUREMENTS: Data assessment regarding preoperative symptoms, perioperative management, morbidity, mortality and longtime results. Comparison of results with data from the literature regarding MEDCO2 , ESED and OTA.

RESULTS: Operation duration: 25 min median; morbidity: 4.7%; mortality: 0%; mediastinitis: 0.9%; hospitalisation: 7 days; feeding tube dependency: 4 days; recurrence rate: 6.1%. Rise of body temperature above 38°C and 39°C in 36.7% and 12.2% of cases on first postoperative day, respectively.

CONCLUSIONS: The results identify MEDCO2 as superior in comparison with ESED and OTA concerning the treatment for Zenker's diverticulum especially in terms of excellent long-term functional results and a low morbidity and mortality. The short operation time qualifies MEDCO2 as specifically suitable for the treatment of the characteristic patient cohort with Zenker's diverticulum, namely the elderly, whereas OTA should be reserved for cases with sophisticated or impossible endoscopic exposure of the pouch. The occurrence of perioperative fever can be managed with a systemic antibiotic and antipyretic medication. Although a mediastinitis as major complication is a rare event, the early introduction of its diagnosis with CT scans and consecutive therapy including thoracotomies can be lifesaving.