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Patients undergoing open surgery for excision of pharyngeal pouch should be warned of the risk to the left recurrent laryngeal nerve with consequent hoarseness, as well as the risk of fistula formation. Since smaller pouches do not pose a threat to life, actions in failure of informed consent are possible in the event of complications of this kind. The occurrence of a fistula does not indicate deficient surgical technique; it is an operative complication. In my view the same is true of recurrent laryngeal nerve injury, but this is harder to defend.