Current trends in management of Zenker diverticulum

Abstract

Zenker's diverticulum is a relatively common problem encountered by head and neck surgeons. Careful review of the available literature regarding its pathogenesis indicates that Zenker diverticulum likely occurs as a result of increased intrabolus pressures during swallowing secondary to cricopharyngeal spasm. Rational treatment for Zenker diverticulum therefore addresses cricopharyngeal spasm. The traditional approach to diagnosis and management of Zenker diverticulum has been based on standard techniques and principles. For example, diverticulectomy with concurrent cricopharyngeal myotomy is an acceptable form of treatment with a high success rate. However, recent advances in endoscopic stapling and carbon dioxide laser technologies have added new options to the therapeutic armament of the otolaryngologist. For appropriately selected patients, endoscopic staple-assisted diverticulostomy is a minimally invasive, safe, and effective procedure associated with shorter hospital stays, more rapid postoperative recovery, decreased time to resumption of oral intake, and high levels of patient satisfaction.

Divertículo faringoesofagiano: avaliação dos resultados do tratamento

“…With this technique, cervical incision was abolished, procedure time and hospital stay shortened, the introduction of the diet abbreviated and the number of complications decreased 6 . After employing the method in more than 100 patients, the authors observed no serious complications, recurrence being reported in only 5% of cases.…”

“…This disease rarely occurs in individuals under 40 years and the decade from 65 to 75 years is the most affected 6 . The pathophysiology of the PED is not yet fully elucidated.…”

Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom

“…If endoscopic diverticulotomy was performed, longterm patient follow-up was advised. Veenker and Cohen [31] suggested that every patient should be assessed by a speech and language therapist to identify other swallowing abnormalities such as cricopharyngeal (CP) spasm (Fig. 5).…”

“…Collectively, these radiological and patient variables are important to inform on potential success at endoscopic stapling and serves as a reminder to exercise greater vigilance during surgery. It may be acceptable to under divide [31] rather than over divide the septum and risk a perforation, although the recurrence rate may be higher [36].…”

Unsere Erfahrungen mit der Zenkerdivertikelresektion

“…Eine kontroverse Frage des offenen chirurgischen Verfahrens ist die Notwendigkeit einer Myotomie. Einige Autoren betrachten die Myotomie als notwendig [9,23], andere [5] nicht. Laut DeMeester [8] kommt es wahrscheinlich durch Vergrößerung des Divertikels zur Erweiterung und Atrophie des M. cricopharyngeus und dadurch zu seiner Insuffizienz.…”