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Endoscopic Stapling Technique for the Treatment of Zenker Diverticulum vs Standard Open-Neck Technique
A Direct Comparison and Charge Analysis
Shane R. Smith, MD;
Eric M. Genden, MD;
Mark L. Urken, MD
Arch Otolaryngol Head Neck Surg. 2002;128:141-144.
Background Presently, the 2 most widely used methods for the treatment of Zenker
diverticulum are endoscopic stapling of the common party wall between the
diverticulum sac and the esophagus and the standard open-neck technique involving
diverticulectomy and cricopharyngeal myotomy.
Objective To perform an analysis of the hospital charges to determine the economic
efficiency of each technique based on our experience at the Mt Sinai Medical
Center, New York, NY.
Methods A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum
was conducted. Eight randomly chosen patients underwent endoscopic stapling
with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and
8 randomly chosen patients underwent a standard open approach with diverticulectomy.
Medical records were reviewed to determine operative time, length of hospital
stay, time to oral intake, and postoperative complications. A charge analysis
of the operative and postoperative fees was also performed. Statistical analysis
between the 2 groups was conducted using analysis of variance and the paired
t test.
Results The mean ± SD operative time for the endoscopic stapling technique
was 25.5 ± 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 ± 35.10 minutes.
The mean operative charges were roughly equivalent at $5178 for the endoscopic
procedure and $5113 for the open procedure. The endoscopic procedure, while
shorter in operative time, had the added expense of specialized equipment,
specifically the EndoGIA endoscopic stapler. The mean ± SD length of
hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 ± 0.59 days vs 5.2 ± 1.03
days for the open procedure. The inpatient hospital charges for the endoscopic
group was also significantly less (P<.001) at
a mean of $3589 per stay vs $11 439 for the open group. The mean ±
SD time to oral intake was significantly shorter (<.001) at a mean of $3589
per stay vs $11 439 for the open group. The mean ± SD time to
oral intake was significantly shorter (P<.001)
in the endoscopic group at 0.8 ± 0.26 days vs 5.1 ± 1.25 days
for the open group. There were no major complications in either group, and
all patients experienced resolution of preoperative symptoms.
Conclusions Compared with the standard open technique, the endoscopic stapling technique
for the treatment of Zenker diverticulum results in a statistically significant
shorter operative time, hospital stay, and time to resume oral feedings. While
the charges of the operative procedures were roughly equivalent, the total
hospital charges were significantly less for the patients treated endoscopically.
From the Department of Otolaryngology, Mt Sinai School of Medicine,
Mt Sinai Medical Center, New York, NY.
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