A decade’s experience of pharyngeal pouch surgery was reported in this paper from Rotterdam. A total of 94 patients were analysed. The majority (80%) underwent an endoscopic approach, either with stapling or CO2 laser-assisted. Interestingly, 13 of 75 (14%) procedures were aborted from the endoscopic approach due to difficult access or if the pouch was too small. Pouch recurrence and complications were reported for each approach including transcervical.
There was no recurrence for the transcervical procedures and there was a slightly higher recurrence rate for stapling (45%) compared with laser (33%). Roughly half of the recurrences were not reoperated on due to symptoms being too mild.
Two of the pouch-stapled patients suffered mediastinitis from a mucosal perforation. No mediastinitis resulted from the one patient that had mucosal damage in the laser group. Finally, one of the transcervical patients had postoperative airway oedema resulting in a tracheostomy, brain hypoxia and subsequent death. Overall, the authors concluded that although each approach had advantages and disadvantages, the endoscopic approach was preferred if the anatomy was favourable since it had a lower morbidity. Both endoscopic approaches had a similar efficacy. Although statistically insignificant, stapling had a slightly higher recurrence and complication rate.