STAGED ZENKERS DIVERTICULECTOMY WITH CERVICAL ESOPHAGOSTOMY AND SECONDARY ESOPHAGOSTOMY CLOSURE FOR TREATMENT OF MASSIVE DIVERTICULUM IN SEVERELY DEBILITATED PATIENTS

Cricopharyngeal myotomy and diverticulectomy have become the standard therapy for the vast majority of patients with pharyngoesophageal dive rticula. Potential complications from this approach, however, may be d evastating in debilitated, elderly patients with massive Zenker's dive rticula. Because of potentially fatal complications, we advocate a sta ged approach to treat debilitated patients with massive Zenker's diver ticula. Ln the first stage, myotomy, diverticulectomy, and cervical es ophagostomy are performed, and a gastric feeding tube is positioned th rough the esophagostomy. After recovery from pulmonary complications a nd nutritional improvement, the feeding tube is removed and the esopha gostomy is closed. From 1987 to 1992, we treated five severely debilit ated patients, four men and one woman with massive Zenker's diverticul a, with this novel approach. Age of the patients averaged 80 years, ra nge 58 to 93. All patients had symptoms of pulmonary aspiration requir ing multiple hospitalizations for life-threatening pneumonia. Three pa tients had severe malnutrition associated with major weight loss and c achexia, All patients underwent first stage repair without morbidity o r mortality. After an average of 7 weeks, patients had significant nut ritional improvement and the esophagostomy was closed. Local wound car e adequately treated one wound infection after esophagostomy closure. Although myotomy and diverticulectomy are safe procedures, a staged ap proach, diverticulectomy and cervical esophagostomy, followed by esoph agostomy closure, is advocated for the elderly, severely debilitated p atient with massive Zenker's diverticulum.