Meditation on the Pathogenesis of Hypopharyngeal (Zenker's) Diverticulum and a Report of Endoscopic Treatment in 545 Patients

Abstract

Much discussion in the literature concerning Zenker's diverticulum is related to etiology. Various theories have been propounded, but no single conclusion is generally accepted. We believe that an anatomic predisposition plays a prominent role. Considerations for this conclusion will be discussed. In the otorhinolaryngology departments of University Hospital and Martini Hospital (Groningen, the Netherlands) 545 patients with a diverticulum were treated endoscopically since 1964. Initially we used the procedure described by Dohlman. With the increase in the number of patients, the technique and instruments used have improved. In 1981 we started to apply a microendoscopic procedure with a special double-lipped scope and the carbon dioxide laser. The rate of complications was very low, and 91% of the patients are highly satisfied. In view of our results, we feel justified in maintaining that endoscopic treatment is a relatively safe and effective method.

Surgical Treatment of Zenker's Diverticulum

“…We identified 6,915 patients from 93 studies evaluating the effect of the surgical treatment for ZD, including 52 studies [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59] (n = 3,336) on endoscopic surgeries, 22 [60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81] (n = 2,204) on open surgeries, and 19 [3,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,…”

Minimally Invasive Surgery for Zenker Diverticulum

“…This procedure has been performed using electrocoagulation or laser; although the results appear satisfactory, complications such as bleeding, perforation and stenosis, and the need for repeated treatment have been reported. 4,5 The introduction of endostaplers has renewed the interest in the transoral treatment of Zenker diverticulum. 6,7 We report the early and intermediate results of the endosurgical approach to pharyngoesophageal diverticula in 95 consecutive patients.…”

Current management in pharyngeal pouch surgery by UK otorhinolaryngologists

“…In comparing the treatment modalities, most series show that the endoscopic and external approaches are equally effective treatments. [11][12][13][14] However, there is no doubt that the external approach has a higher complication rate, including vocal cord paralysis, mediastinitis, fistula formation, glottic oedema and stricture formation. 11,15,16 However, these studies were retrospective, lacked criteria for selecting patients, and the procedures were performed by a large number of surgeons from several specialities.…”

“…It is thus difficult to draw firm conclusions as to which is the better method of treatment, although in centres performing endoscopic diverticulotomy as a first line treatment for pharyngeal pouches, the results seem to be consistently good. 12,17,18 Endoscopic stapling devices were first described in 1993 by Hirsh and Newbegin. 10 The advantages of using a stapling device over laser or diathermy are a reduced risk of perforation and subsequent mediastinitis as the divided edges of the septum are sealed by the staples, better haemostasis and avoidance of thermal damage to the recurrent laryngeal nerve.…”