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The endoscopic division of the pharyngeal pouch wall with a mechanical stapling device has become increasingly popular. When compared to open excision, the reduced operative time, early resumption of oral intake, and short in-patient stay with no early recurrence of symptoms, are the proposed advantages. Small pouches or thick walled pouches are not suitable for stapling. From December 1996 to December 1999, 32 patients were admitted to the Aberdeen Royal Infirmary for endoscopic stapling of a pharyngeal pouch. Five patients were unsuitable for stapling. In addition, three patients were treated for pouch recurrence after an external approach. Two patients required repeat stapling at a later date. Our results are encouraging in terms of short operation time and hospital admission, improvement of symptoms and minimal complication rate. Fifteen patients were assessed 24 months after the procedure with satisfaction surveys and contrast swallow X-rays. Subjective improvement was sustained throughout this period, despite radiological evidence of persistence of the pharyngeal pouch.
A 71-year-old female presented with a midline neck mass. The clinical impression was that of a thyroglossal cyst but preoperative assessment suggested a solid lesion, possibly malignant. The mass was removed surgically using the Sistrunk technique and shown pathologically to be a mixed papillary-follicular carcinoma of the thyroid with no cystic elements. Clinically and radiologically the thyroid was normal and thyroidectomy was not performed. This management is discussed along with a brief review of the relevant literature on the pathology and treatment of similar lesions.