Zenker diverticulum

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Luigi Bonavina - One of the best experts on this subject based on the ideXlab platform.

  • Respiratory Symptoms and Complications of Zenker diverticulum: Effect of Trans-Oral Septum Stapling
    Journal of Gastrointestinal Surgery, 2017
    Co-Authors: Stefano Siboni, Emanuele Asti, Marco Sozzi, Gianluca Bonitta, Matteo Melloni, Luigi Bonavina
    Abstract:

    Background Zenker diverticulum is a rare condition commonly associated with dysphagia and respiratory symptoms/complications, which are alarming especially in the elderly population. Aim of this study was to investigate the prevalence of respiratory symptoms/complications and the effects of minimally invasive trans-oral surgery in these patients. Methods Consecutive adult patients who underwent trans-oral septum stapling for Zenker diverticulum were included in a retrospective, observational cohort study. Pre- and postoperative symptoms, including chronic cough and aspiration pneumonia, were evaluated using a dedicated foregut questionnaire and were recorded on a prospectively maintained database. The operation was performed under general anesthesia. A barium swallow study and an upper gastrointestinal endoscopy were performed 6 months after the operation, and the foregut questionnaire was administered yearly. Results A total of 139 patients were finally included in the study. The median age was 72 years. In 62 (44.6%, CI 36.2–53.3) patients, there was a history of chronic cough and/or aspiration pneumonia. Chronic cough was associated with pneumonia ( p  

  • respiratory symptoms and complications of Zenker diverticulum effect of trans oral septum stapling
    Journal of Gastrointestinal Surgery, 2017
    Co-Authors: Stefano Siboni, Emanuele Asti, Marco Sozzi, Gianluca Bonitta, Matteo Melloni, Luigi Bonavina
    Abstract:

    Background Zenker diverticulum is a rare condition commonly associated with dysphagia and respiratory symptoms/complications, which are alarming especially in the elderly population. Aim of this study was to investigate the prevalence of respiratory symptoms/complications and the effects of minimally invasive trans-oral surgery in these patients.

  • current status of minimally invasive endoscopic management for Zenker diverticulum
    World Journal of Gastrointestinal Endoscopy, 2015
    Co-Authors: Alberto Aiolfi, Federica Scolari, Greta Saino, Luigi Bonavina
    Abstract:

    Surgical resection has been the mainstay of treatment of pharyngoesophageal (Zenker) diverticula over the past century. Developments in minimally invasive surgery and new endoscopic devices have led to a paradigm change. The concept of dividing the septum between the esophagus and the pouch rather than resecting the pouch itself has been revisited during the last three decades and new technologies have been investigated to make the transoral operation safe and effective. The internal pharyngoesophageal myotomy accomplished through the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum.

  • long term outcome and quality of life after transoral stapling for Zenker diverticulum
    World Journal of Gastroenterology, 2015
    Co-Authors: Luigi Bonavina, Davide Bona, Alberto Aiolfi, Federica Scolari, Andrea Lovece, Emanuele Asti
    Abstract:

    AIM: 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). CONCLUSION: 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.

  • Transoral stapling for Zenker diverticulum: effect of the traction suture-assisted technique on long-term outcomes
    Surgical Endoscopy, 2012
    Co-Authors: Luigi Bonavina, Matteo Rottoli, Davide Bona, Stefano Siboni, Iris S Russo, Daniele Bernardi
    Abstract:

    Background Long-term outcomes and predictors of success after transoral stapling for Zenker diverticulum are still unclear. Methods Between 2001 and 2010, 91 patients with Zenker diverticulum underwent transoral stapling under general anesthesia. Since 2008, the technique was modified by applying traction sutures to ease engagement of the common septum inside the stapler jaws. Perioperative variables, distribution of symptoms, and outcome of surgery were analyzed. Long-term results were compared between patients undergoing standard versus modified technique of transoral stapling. Results The transoral approach was successfully completed in 79 (86.8 %) patients with a median age of 74 years. Overall morbidity was 5 %, and there was no mortality. The median length of hospital stay was 2 days. Six patients were lost to follow-up. After a median follow-up of 53 (range, 12–114) months, an improvement of dysphagia and regurgitation scores ( p  

Stefano Siboni - One of the best experts on this subject based on the ideXlab platform.

  • Respiratory Symptoms and Complications of Zenker diverticulum: Effect of Trans-Oral Septum Stapling
    Journal of Gastrointestinal Surgery, 2017
    Co-Authors: Stefano Siboni, Emanuele Asti, Marco Sozzi, Gianluca Bonitta, Matteo Melloni, Luigi Bonavina
    Abstract:

    Background Zenker diverticulum is a rare condition commonly associated with dysphagia and respiratory symptoms/complications, which are alarming especially in the elderly population. Aim of this study was to investigate the prevalence of respiratory symptoms/complications and the effects of minimally invasive trans-oral surgery in these patients. Methods Consecutive adult patients who underwent trans-oral septum stapling for Zenker diverticulum were included in a retrospective, observational cohort study. Pre- and postoperative symptoms, including chronic cough and aspiration pneumonia, were evaluated using a dedicated foregut questionnaire and were recorded on a prospectively maintained database. The operation was performed under general anesthesia. A barium swallow study and an upper gastrointestinal endoscopy were performed 6 months after the operation, and the foregut questionnaire was administered yearly. Results A total of 139 patients were finally included in the study. The median age was 72 years. In 62 (44.6%, CI 36.2–53.3) patients, there was a history of chronic cough and/or aspiration pneumonia. Chronic cough was associated with pneumonia ( p  

  • respiratory symptoms and complications of Zenker diverticulum effect of trans oral septum stapling
    Journal of Gastrointestinal Surgery, 2017
    Co-Authors: Stefano Siboni, Emanuele Asti, Marco Sozzi, Gianluca Bonitta, Matteo Melloni, Luigi Bonavina
    Abstract:

    Background Zenker diverticulum is a rare condition commonly associated with dysphagia and respiratory symptoms/complications, which are alarming especially in the elderly population. Aim of this study was to investigate the prevalence of respiratory symptoms/complications and the effects of minimally invasive trans-oral surgery in these patients.

  • Transoral stapling for Zenker diverticulum: effect of the traction suture-assisted technique on long-term outcomes
    Surgical Endoscopy, 2012
    Co-Authors: Luigi Bonavina, Matteo Rottoli, Davide Bona, Stefano Siboni, Iris S Russo, Daniele Bernardi
    Abstract:

    Background Long-term outcomes and predictors of success after transoral stapling for Zenker diverticulum are still unclear. Methods Between 2001 and 2010, 91 patients with Zenker diverticulum underwent transoral stapling under general anesthesia. Since 2008, the technique was modified by applying traction sutures to ease engagement of the common septum inside the stapler jaws. Perioperative variables, distribution of symptoms, and outcome of surgery were analyzed. Long-term results were compared between patients undergoing standard versus modified technique of transoral stapling. Results The transoral approach was successfully completed in 79 (86.8 %) patients with a median age of 74 years. Overall morbidity was 5 %, and there was no mortality. The median length of hospital stay was 2 days. Six patients were lost to follow-up. After a median follow-up of 53 (range, 12–114) months, an improvement of dysphagia and regurgitation scores ( p  

  • transoral stapling for Zenker diverticulum effect of the traction suture assisted technique on long term outcomes
    Surgical Endoscopy and Other Interventional Techniques, 2012
    Co-Authors: Luigi Bonavina, Matteo Rottoli, Davide Bona, Stefano Siboni, Iris S Russo, Daniele Bernardi
    Abstract:

    Background Long-term outcomes and predictors of success after transoral stapling for Zenker diverticulum are still unclear.

Davide Bona - One of the best experts on this subject based on the ideXlab platform.

  • long term outcome and quality of life after transoral stapling for Zenker diverticulum
    World Journal of Gastroenterology, 2015
    Co-Authors: Luigi Bonavina, Davide Bona, Alberto Aiolfi, Federica Scolari, Andrea Lovece, Emanuele Asti
    Abstract:

    AIM: 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). CONCLUSION: 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.

  • Transoral stapling for Zenker diverticulum: effect of the traction suture-assisted technique on long-term outcomes
    Surgical Endoscopy, 2012
    Co-Authors: Luigi Bonavina, Matteo Rottoli, Davide Bona, Stefano Siboni, Iris S Russo, Daniele Bernardi
    Abstract:

    Background Long-term outcomes and predictors of success after transoral stapling for Zenker diverticulum are still unclear. Methods Between 2001 and 2010, 91 patients with Zenker diverticulum underwent transoral stapling under general anesthesia. Since 2008, the technique was modified by applying traction sutures to ease engagement of the common septum inside the stapler jaws. Perioperative variables, distribution of symptoms, and outcome of surgery were analyzed. Long-term results were compared between patients undergoing standard versus modified technique of transoral stapling. Results The transoral approach was successfully completed in 79 (86.8 %) patients with a median age of 74 years. Overall morbidity was 5 %, and there was no mortality. The median length of hospital stay was 2 days. Six patients were lost to follow-up. After a median follow-up of 53 (range, 12–114) months, an improvement of dysphagia and regurgitation scores ( p  

  • transoral stapling for Zenker diverticulum effect of the traction suture assisted technique on long term outcomes
    Surgical Endoscopy and Other Interventional Techniques, 2012
    Co-Authors: Luigi Bonavina, Matteo Rottoli, Davide Bona, Stefano Siboni, Iris S Russo, Daniele Bernardi
    Abstract:

    Background Long-term outcomes and predictors of success after transoral stapling for Zenker diverticulum are still unclear.

  • long term results of endosurgical and open surgical approach for Zenker diverticulum
    World Journal of Gastroenterology, 2007
    Co-Authors: Luigi Bonavina, Davide Bona, Greta Saino, Medhanie Abraham, Emmanuele Abate
    Abstract:

    AIM: To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum. METHODS: Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years. RESULTS: The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3 cm). CONCLUSION: Both operations relieve the outflow obstruction at the pharyngoesophageal junction, indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach. Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter.

Daniele Bernardi - One of the best experts on this subject based on the ideXlab platform.

Emanuele Asti - One of the best experts on this subject based on the ideXlab platform.

  • Respiratory Symptoms and Complications of Zenker diverticulum: Effect of Trans-Oral Septum Stapling
    Journal of Gastrointestinal Surgery, 2017
    Co-Authors: Stefano Siboni, Emanuele Asti, Marco Sozzi, Gianluca Bonitta, Matteo Melloni, Luigi Bonavina
    Abstract:

    Background Zenker diverticulum is a rare condition commonly associated with dysphagia and respiratory symptoms/complications, which are alarming especially in the elderly population. Aim of this study was to investigate the prevalence of respiratory symptoms/complications and the effects of minimally invasive trans-oral surgery in these patients. Methods Consecutive adult patients who underwent trans-oral septum stapling for Zenker diverticulum were included in a retrospective, observational cohort study. Pre- and postoperative symptoms, including chronic cough and aspiration pneumonia, were evaluated using a dedicated foregut questionnaire and were recorded on a prospectively maintained database. The operation was performed under general anesthesia. A barium swallow study and an upper gastrointestinal endoscopy were performed 6 months after the operation, and the foregut questionnaire was administered yearly. Results A total of 139 patients were finally included in the study. The median age was 72 years. In 62 (44.6%, CI 36.2–53.3) patients, there was a history of chronic cough and/or aspiration pneumonia. Chronic cough was associated with pneumonia ( p  

  • respiratory symptoms and complications of Zenker diverticulum effect of trans oral septum stapling
    Journal of Gastrointestinal Surgery, 2017
    Co-Authors: Stefano Siboni, Emanuele Asti, Marco Sozzi, Gianluca Bonitta, Matteo Melloni, Luigi Bonavina
    Abstract:

    Background Zenker diverticulum is a rare condition commonly associated with dysphagia and respiratory symptoms/complications, which are alarming especially in the elderly population. Aim of this study was to investigate the prevalence of respiratory symptoms/complications and the effects of minimally invasive trans-oral surgery in these patients.

  • long term outcome and quality of life after transoral stapling for Zenker diverticulum
    World Journal of Gastroenterology, 2015
    Co-Authors: Luigi Bonavina, Davide Bona, Alberto Aiolfi, Federica Scolari, Andrea Lovece, Emanuele Asti
    Abstract:

    AIM: 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). CONCLUSION: 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.