Objective: Transoral endoscopic laser-assisted diverticulotomy (TELD) with diverticulectomy and diverticuloplasty (TELD + DD) for the management of Zenker's diverticulum (ZD) has been utilized by our institution since 2016 in attempts to reduce residual pouch size. This technique involves complete endoscopic pouch excision with partial advancement of mucosal flaps. Our study compares the subjective outcomes, objective outcomes, and complication rates between TELD and TELD + DD.
Methods: A retrospective cohort study was performed on patients who underwent TELD or TELD + DD by a single surgeon at a tertiary academic center (2013-2019). Videofluoroscopic swallow studies (VFSS) with esophagram, Eating Assessment Tool (EAT-10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and 3 month follow-up visits. A single blinded reviewer recorded height, width, and depth of pre and postoperative pouches with volumetric analysis performed assuming an ellipsoid shape. Comorbidities, complications, postoperative course, and recurrence were recorded.
Results: Of the 75 patients that met criteria, 27 underwent TELD + DD and 48 underwent TELD. Eighteen TELD + DD and 37 TELD had both pre and post-operative VFSS. TELD + DD and TELD had a 96 ± 7% and 87 ± 16% reduction in pouch volume, respectively (-test; = .01). Complications (TELD + DD 7%, TELD 17%, fisher's exact; = .31) and final subjective outcomes after adjusting for initial were not significantly different between methods (EAT-10 with TELD + DD ∆ + 1.3, = .18; RSI ∆ + 1.4, = .29; FOSS ∆-0.02, = .91). One short-term recurrence was reported with TELD.
Conclusion: Use of TELD + DD is associated with a statistically significantly decreased residual pouch size with no significant difference in short-term subjective outcomes. Complication rates and short-term recurrence rates are comparable. Long-term recurrence rates will require further studies to characterize.
Level Of Evidence: Level 3.
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http://dx.doi.org/10.1177/00034894211012589 | DOI Listing |
JAMA Ophthalmol
January 2025
Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China.
Importance: After cataract surgery, postoperative residual astigmatism can influence a patient's visual quality and satisfaction. Finding ways to minimize this astigmatism is important.
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JAMA Netw Open
January 2025
Department of Child and Adolescent Psychiatry-Psychotherapy, University Hospital Ulm, Ulm, Germany.
Importance: Associations between child maltreatment (CM) and health have been studied broadly, but most studies focus on multiplicity (number of experienced subtypes of CM). Studies assessing multiple CM characteristics are scarce, partly due to methodological challenges, and were mostly conducted in patient samples.
Objective: To determine the importance of CM characteristics in association with physical multimorbidity in adulthood for women and men in a German representative sample.
Oral Maxillofac Surg
January 2025
North Cumbria University Hospitals NHS Trust, Carlisle, UK.
Introduction: Increasing emphasis has been placed on measurement of quality of life (QOL) as a central criterion for assessment of success of any medical treatment. The aim of our study was to assess the nutritional and quality of life of patient-reported outcomes among patients who have undergone laser resection of tongue cancer.
Materials And Methods: A cross-sectional study was undertaken of patients treated with KTP laser resection of T1/T2 tongue squamous cell carcinoma (SCC) between 2011-2019.
Geriatrics (Basel)
January 2025
Department of Psychology of the Personality, Evaluation and Psychological Treatments, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain.
With ageing population projections, promoting positive ageing trajectories is critical. While health is often emphasised, eudaimonic psychological factors remain underexamined. A qualitative study presented throughout the main text highlighted the importance of psychological factors like purpose in life and resilience in fostering participation and subjective well-being, even amidst declining health.
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January 2025
Ngudi Waluyo General Hospital, Blitar 65142, East Java, Indonesia.
Introduction: Knee joint stability is influenced by force distribution and ligament structures. High Tibial Osteotomy (HTO) treats knee deformities and redistributes load, reducing further invasive procedures. High Tibial Osteotomy (HTO) is a well-established procedure for addressing knee instability, particularly in cases involving ligament deficiencies such as ACL and PCL insufficiencies.
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