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Surgical therapy of Zenker's diverticulum: Low risk and high efficiency

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Abstract

Surgery for the treatment of Zenker's diverticulum was performed at our institution in a total of 43 patients over 6½ years. Cervical myotomy with diverticulectomy was performed in 32 of the patients and myotomy alone in 11. Mortality totaled 0%, with a reversible lesion of the recurrent nerve occurring in 7%.

In 60% of the cases investigated preoperatively (N=40), motility disorders of the upper esophageal sphincter (UES) could be demonstrated using manometry as well as with cineradiography in 92% of the patients. Follow-up studies in 39 of the cases 25 months (mean) postprocedure indicated 82% of the patients to be symptom-free, with the remaining 18% demonstrating a marked improvement. Postoperative manometry as well as cineradiography carried out in 12 patients revealed the presence of UES motility dyscoordination in 8% and 25%, respectively. There were, however, no signs of recurrence of the diverticulum.

The high number of patients in our study group demonstrating motility disorders of the UES emphasizes the need for cervical myotomy as part of the surgical therapy for Zenker's diverticulum.

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References

  1. Borrie J, Wilson RLK: Oesophageal diverticula: principles of management and appraisal of classification.Thorax 35:759–767, 1980

    Article  CAS  PubMed  Google Scholar 

  2. Hunt PS, Connell AM, Smiley TB: The cricopharyngeal sphincter in gastric reflux.Gut 11:303–306, 1970

    CAS  PubMed  Google Scholar 

  3. Hurwitz AL, Nelson JA, Haddad JK: Oropharyngeal dysphagia-manometric and cine esophagographic findings.Dig Dis 20(4):313–324, 1975

    Article  CAS  Google Scholar 

  4. Ellis FH, Crozier RE: Cervical esophageal dysphagia.Ann Surg 194(3):279–289, 1981

    PubMed  Google Scholar 

  5. Lichter I: Motor disorder in pharyngoesophageal pouch.J Thorac Cardiovasc Surg 76(2):272–275, 1978

    CAS  PubMed  Google Scholar 

  6. Skinner DB, Altorki N, Ferguson M, Little G: Zenker's diverticulum: clinical features and surgical management.Dis Esoph 1(1):19–22, 1988

    Google Scholar 

  7. Duranceau A, Rheault MJ, Jamieson GG: Physiologic response to cricopharyngeal myotomy and diverticulum suspension.Surgery 94:655–662, 1983

    CAS  PubMed  Google Scholar 

  8. Knuff TE, Benjamin SB, Castell DO: Pharyngoesophageal (Zenker's) diverticulum: a reappraisal.Gastroenterology 32:734–736, 1982

    Google Scholar 

  9. Brombart MM:Gastrointestinal Radiology. Stuttgart: Georg Thieme, 1980

    Google Scholar 

  10. Hannig Ch, Wuttge-Hannig A: Kinematographie des Ösophagus.Roentgenpraxis 10:358–377, 1987

    Google Scholar 

  11. Weiser HF, Hölscher A, Siewert JR: Gastroösophagealer Reflux: Besteht eine Korrelation zwischen Refluxausmass und Refluxfolgen?Dtsch Med Wochenschr 108:930–935, 1983

    Article  CAS  PubMed  Google Scholar 

  12. Bowdler DA, Stell PM: Surgical management of posterior pharyngeal pulsion diverticula: inversion versus one-stage excision.Br J Surg 74:561–563, 1987

    CAS  PubMed  Google Scholar 

  13. Luckhaupt H, Rose KG: Behandlung und Behandlungsergebnisse beim Zenker'schen Divertikel.HNO 32:35–37, 1984

    CAS  PubMed  Google Scholar 

  14. Low DE, Hill LD: Cervical esophageal web associated with Zenker's diverticulum.Am J Surg 156:34–37, 1988

    CAS  PubMed  Google Scholar 

  15. Payne WS, King RM: Pharyngoesophageal (Zenker's) diverticulum.Surg Clin North Am 63:815–824, 1983

    CAS  PubMed  Google Scholar 

  16. Raab M, Gutierrez F, Heindel W: Divertikelabtragung und Myotomic zur Behandlung des Zenkerschen Divertikels.Med Klin 81:592–595, 1986

    CAS  Google Scholar 

  17. Mercer CD, Hill LD: Esophageal web associated with Zenker's diverticulum: a possible cause of continuing dysphagia after diverticulectomy.Can J Surg 28:375–376, 1985

    CAS  PubMed  Google Scholar 

  18. Lerut T, Guelinckx P, Dom R, Geboes K, Gruwez J: Does the musculus cricopharyngeus play a role in the genesis of Zenker's diverticulum? Enzyme histochemical and contractility properties. In Siewert JR, Hölscher AH (eds):Diseases of the esophagus. Berlin/Heidelberg: Springer Verlag, 1988, pp 1018–1023

    Google Scholar 

  19. Escher F: Zur Therapie des Zenker'schen Divertikels.Schweiz Med Wochenschr 114:1428–1433, 1984

    CAS  PubMed  Google Scholar 

  20. Franke KD, Weiss R: Die Myotomic (pars fundiformis m. cricopharyngei) bei der Behandlung Zenkerscher Divertikel.HNO 32:32–34, 1984

    CAS  PubMed  Google Scholar 

  21. Huang B, Krishnan K, Payne WS: Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum.Ann Thorac Surg 38:207–210, 1984

    Article  CAS  PubMed  Google Scholar 

  22. Baron SH: Zenker's diverticulum as a cause for loss of drug availability: a “new” complication.Am J Gastroenterol 77:152–153, 1982

    CAS  PubMed  Google Scholar 

  23. Todd GB: The treatment of pharyngeal pouch.J Laryngol Otol 88:307–315, 1974

    CAS  PubMed  Google Scholar 

  24. Overbeek van JJM, Hoeksema PE: Endoscopic treatment of the hypopharyngeal diverticulum: 211 cases.Laryngoscope 92:88–91, 1982

    PubMed  Google Scholar 

  25. Mackay IS: The treatment of pharyngeal pouch.J Laryngol Otol 90:183–190, 1976

    CAS  PubMed  Google Scholar 

  26. Holinger PH, Schild JA: The Zenker's (hypopharyngeal) diverticulum.Ann Otol Rhinol Laryngol 78:679–688, 1969

    CAS  PubMed  Google Scholar 

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Barthlen, W., Feussner, H., Hannig, C. et al. Surgical therapy of Zenker's diverticulum: Low risk and high efficiency. Dysphagia 5, 13–19 (1990). https://doi.org/10.1007/BF02407389

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