Endoscopic diverticulotomy for Killian-Jamieson diverticulum: mid-term outcome and description of an ultra-short tunnel technique

Background and study aims Killian-Jamieson Diverticulum (KJD) is a rarer and more recently described upper pharyngeal diverticulum than Zenker’s diverticulum (ZD). KJD is more difficult to manage than ZD because it tends to extend lower into the upper mediastinum and the diverticulum neck is in close proximity to the recurrent laryngeal nerve. There is limited literature on KJD management and transcervical surgical diverticulectomy is the mainstay of therapy. Patients and methods Here we describe two methods of endoscopic diverticulotomy to treat KJD – direct and tunneling diverticulotomy (with hypopharyngeal tunnel or ultra-short tunnel – the latter being our preferred technique). Results This was a retrospective study including 13 consecutive patients between March 2015 and April 2018. Three patients received direct and 10 received tunneling diverticulotomy (7 with the hypopharyngeal tunnel and 3 with the ultra-short tunnel). All procedures were completed in 16 to 52 minutes. There was no incidence of bleeding, mediastinitis, or sign of recurrent laryngeal nerve injury. At follow up of 9 to 79 months (median 33), the clinical success rate was 92 % (12/13); 11 patients had complete symptom resolution (post-operative symptom score = 0) and one patient had near-complete symptom resolution (occasional residual dysphagia). One patient receiving direct myotomy had limited symptom relief (frequent residual dysphagia and occasional residual regurgitation), possibly related to incomplete myotomy. Conclusions Endoscopic tunneling diverticulotomy is a feasible, safe, and effective method to treat KJD.

THYROID SURGERY: A COMPARISON OF COMMON COMPLICATIONS BETWEEN EXPERTS AND SURGEONS IN TRAINING

Objective: To determine the frequency of common complications of thyroid surgery by two types of surgeons. Study Design: Comparative cross sectional. Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Peshawar, from Jan 2013 to Dec 2017. Methodology: This study was conducted to assess the role of surgical skills in complications of thyroid surgery. Surgeons performing surgery for more than 5 years were considered expert and less than 5 years of experience were considered trainee for this specific surgery. Complications by both were analyzed by SPSS-21 and descriptive statistics were applied. Results: A total of 482 surgeries were performed. Out of 407 were female and 75 were males. Mean age was 43.55 ± 10.9 years. Expert surgeons performed 300 cases and 16 (5.3%) experienced some complication in 6 months of follow up.182 cases were performed by surgeons with lesser experience and 14 (7.5%) cases developed complications over the period of follow up. Recurrent laryngeal nerve paralysis occurred in 2 (0.67%) of experienced surgeons cases while 6 cases (3.2%) of less experienced surgeons had the similar complication. Conclusion: While the overall complication rates are not much different between experienced and lesser experienced surgeons, the rate of recurrent laryngeal nerve paralysis is significantly more, though still within the acceptable international complication rate for this particular surgery.