OUTCOME ANALYSIS OF ZENKERS DIVERTICULECTOMY AND CRICOPHARYNGEAL MYOTOMY

Background. The optimal management of Zenker's diverticula is controve rsial in part because of the method of categorizing treatment success or failure. Subjective and objective radiologic tests have been used t o evaluate the various treatment modalities. There seems to be poor co rrelation between subjective and objective findings, and we tested thi s hypothesis in a group of patients undergoing one form of therapy (di verticulectomy and cricopharyngeal myotomy [CPM]). Methods. Eighteen c onsecutive patients underwent Zenker's diverticulectomy and CPM. Posto perative symptoms and abnormalities detected by barium esophagrams wer e evaluated after a mean follow-up of 30.3 months (range, 7-74 months) . Results. Three of 18 patients (17%) complained of dysphagia (2 occas ional and not bothersome; 1 bothersome and affecting dietary intake). Postoperative static contrast esophagrams were interpreted without kno wledge of the subjective symptoms. Small diverticula were identified i n 8 patients (44%). There was poor correlation between symptoms and ob jective radiographic abnormalities with agreement of 56% and a kappa s tatistic of 0.23. Conclusions. Objective radiographic abnormalities ar e far more common than subjective complaints following diverticulectom y and CPM. Postoperative static contrast radiography is not routinely required and may be misleading because of the poor correlation between symptoms and radiographic findings. The value of dynamic videofluoros copy needs to be evaluated. (C) 1995 John Wiley & Sons, Inc.