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.
