Aktuelle Behandlungskonzepte des Zenker- Divertikels - Indikationen und Ergebnisse

Abstract

Conventional transcervical therapy of Zenker's diverticulum comprises diverticulectomy, invagination, diverticulopexy and myotomy, which may be combined with the aforementioned methods. Transoral diverticuloesophagostomy is performed by diathermy, lasers or staplers through a rigid esophagoscope, or more recently by diathermy applied via a flexible endoscope. Morbidity of transcervical procedures ranges between 3 (myotomy) and 23 % (diverticulectomy + myotomy). The percentage of patients with at least significantly improved symptoms is 92 % or more, while recurrences occur in 5.7 (diverticulectomy alone) to 21 % (invagination). Transoral procedures have a morbidity of 9 (stapler) to 26 % (Laser), while symptoms improve in 91 (diathermy through rigid esophagoscope) to 99 % (diathermy via flexible endoscope), however in up to 64 % of patients reoperations are necessary. Small diverticula (Brombart I/II) can be treated by diverticulectomy (with/without myotomy) or flexible endoscopy, larger diverticula in general by all methods. Patients younger than 60 years should undergo diverticulectomy, elderly multimorbid patients should be treated by transoral procedures.

Evaluation of the Different Transcervical Approaches for Zenker Diverticulum

“…5 The technique was not used in the present group of patients, and in the authors' view, it appears to be applicable only in patients with larger, mobile diverticulum sacs. In addition, the surgical trauma caused to the soft tissues of the neck with this method is comparable with that with the other transcervical techniques.…”

“…5,[10][11][12] Although this technique leaves the esophageal mucosa intact, recurrences due to insufficiency of the …”

“…3,4 Cricopharyngeal myotomy, either alone or in combination with resection of the diverticulum sac, and closure of the hypopharyngeal wall (diverticulectomy), suspension (diverticulopexy), or inversion of the pharyngeal pouch are the recommended open surgical procedures. 5 However, it should be emphasized that the key step in surgery for ZD appears to be a thorough and adequate cricopharyngeal myotomy. 6 In the present study, diverticulectomy was compared with diverticulum inversion in relation to the mean anesthesia time, duration of hospitalization, incidence of complications, recurrence rate, and follow-up results.…”

Unsere Erfahrungen mit der Zenkerdivertikelresektion

“…Neben der subjektiven Bewertung sollte standardmäßig auch die objektive tikeln kann man zur Therapie alle chirurgischen oder endoskopischen therapeutischen Modalitäten nutzen [6].…”

“…Die perioperative Endoskopie ist auch für die Kontrolle der Naht geeignet.Perioperative Verletzungen des NLR gehören, neben Halsfisteln, zu den häufigsten Komplikationen nach Operationen des ZD. In unserem Krankengut sind einseitige Verletzungen des NLR in 6,7 % (2 Fälle) beobachtet worden, was mit der Literatur vergleichbar ist[6]. Zur einfacheren Verifizierung und Lokalisierung des NLR könnte das perioperative NLR-Neuromonitoring beitragen, bei dem es gelingt, den Verlauf des Nerven in bis zu 99 % der Fälle zu verifizieren, was das Risiko der dauerhaften Verletzung senkt[10,12].…”