ZENKERS DIVERTICULUM IN THE ELDERLY - IS OPERATION JUSTIFIED

Background. Surgical correction of symptomatic Zenker's diverticulum i s effective; however, elderly symptomatic patients may be denied surgi cal intervention because of perceived increased risks. Methods. To add ress this concern, we reviewed 75 patients (46 men and 29 women) found to have this condition during the past two decades. Results. Median a ge was 79 years (range, 75 to 91 years). Preoperative symptoms include d dysphagia in 69 patients (92%), regurgitation in 61 (81%), pneumonia in 9 (12%), halitosis in 3 (4%), and weight loss in 1 (1%). Gastroeso phageal reflux symptoms were noted in 27 patients (36%). Diagnosis was made by barium swallow in 63 patients, esophagoscopy in 5, and a comb ination of both in 7. Surgical procedures included both diverticulecto my and myotomy in 57 patients (76%), myotomy alone in 9 (12%), diverti culopexy and myotomy in 5 (7%), and diverticulectomy alone in 4 (5%). There was no in-hospital mortality. Complications occurred in 8 patien ts (11%) and included esophagocutaneous fistula in 4, pneumonia and ur inary tract infection in I, and wound infection, myocardial infarction , and persistent diverticulum in 1 each. Follow-up was available in 72 patients (96%) and ranged from 8 days to 17 years (median, 3.3 years) . At follow-up, 64 patients (88%) were asymptomatic and 4 (6%) were im proved with minimal symptoms. The remaining 4 patients (6%) have had v arying degrees of dysphagia and all have been treated with periodic es ophageal dilations. Conclusions. Operation for symptomatic Zenker's di verticulum in the elderly is safe and effective and will result in res olution of symptoms and improved quality of life in most patients (C) 1998 by The Society of Thoracic Surgeons.