Results of reoperation on the upper esophageal sphincter

Objective: Reoperation on the upper esophageal sphincter is infrequent. We reviewed our experience in patients who underwent reoperation on the upper esophageal sphincter, Methods: This is a retrospective report of accumulati ve series from 2 separate institutions, Results: From September 1, 1976, to February 28, 1997, 37 patients underwent reoperation on the upper esophage al sphincter for recurrent or persistent obstructive symptoms. There were 2 9 men and 8 women. The median age was 69 Sears (range, 38-87 years), The or iginal indication for the operation was a pharyngoesophageal (Zenker's) div erticulum in 33 patients (89.2%), oculopharyngeal dystrophy in 3 patients ( 8.1%), and muscular dystrophy in 1 patient (2.7%), One prior upper esophage al sphincter operation had been performed in 26 patients (70.3%), two opera tions in 9 patients (24.3%!, and three operations in 2 patients (5.4%). All patients were symptomatic; 35 patients (94.6%) had dysphagia; 23 patients (62.2%) had regurgitation; and 12 patients (32.4%) had episodes of aspirati on. Thirty of the patients (91.0%) with Zenker's diverticulum were found to have a recurrent or persistent diverticulum at reoperation. A diverticulec tomy and cricopharyngeal myotomy were performed in 23 patients (62.2%); cri copharyngeal myotomy alone, in 7 patients (18.9%); diverticulopexy and cric opharyngeal myotomy, in 6 patients (16.2%); and diverticulectomy alone, in 1 patient (2.7%), There were no operative deaths. Complications developed i n 10 patients (27.0%). Follow-up was complete in 33 patients (91.9%) and ra nged from 3 to 149 months (median, 39 mo). Thirty-two patients (94.1%) were improved, Functional results were classified as excellent in 26 patients ( 76.5%), good in 2 patients (5.9%), fair in 4 patients (11.7%), and poor in 2 patients (5.9%). Conclusions: Reoperation for patients who have persisten t or recurrent symptoms after an operation on the upper esophageal sphincte r is associated with acceptable morbidity and mortality rates. Resolution o f symptoms occurs in most patients.