Endoscopic stapling for pharyngeal pouch is generally considered to be less invasive, safe and with fewer complications, resulting in quicker recovery and a shorter hospital stay. Whether these factors hold in the long-term follow-up is the subject of this interesting study. This retrospective study looked at 120 pharyngeal pouch procedures in 97 patients. These patients underwent a number of different procedures ranging from endoscopic stapling to cricopharyngeal myotomy alone or combined with excision or only inversion and suspension of the pharyngeal pouch. Fewer patients commenced oral intake by second postoperative day in the open surgery group. There was no statistically significant difference in the short-term improvement of symptoms between the two groups, but recurrence of symptoms was significantly higher in the stapling group, this being 26% as opposed to 7.5% in the open surgery group. Endoscopic stapling required multiple procedures in 32% of patients, some having to be abandoned whereas no surgical repetitions were required in open transcervical surgery. The hospital stay equated to the stapling group if excision (mucosal breach) was circumvented in open surgery. This is a limited study, being retrospective and non-randomised with details of patient selection such as fitness for open surgery not included but does evoke interesting thoughts on the more recent and perhaps more widely accepted procedure of endoscopic stapling.