Zenker's diverticulostomy with cricopharyngeal myotomy - The endoscopic approach

Citation
J. Adams et al., Zenker's diverticulostomy with cricopharyngeal myotomy - The endoscopic approach, SURG ENDOSC, 15(1), 2001, pp. 34-37
Citations number
8
Categorie Soggetti
Surgery
Journal title
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
ISSN journal
09302794 → ACNP
Volume
15
Issue
1
Year of publication
2001
Pages
34 - 37
Database
ISI
SICI code
0930-2794(200101)15:1<34:ZDWCM->2.0.ZU;2-M
Abstract
Background: The gold standard for the surgical treatment of Zenker's divert iculum is diverticulectomy and cricopharyngeal myotomy by an external appro ach. Unfortunately, many of the patients who present with this entity are e lderly and have significant comorbidities that increase operative risk. Tra ditional minimally invasive approaches have not met with widespread success . However, by combining the exposure afforded by the otolaryngologist's new er bivalved operating laryngoscopes with the operative techniques made poss ible by the general surgeon's laparoscopic instrumentation and staplers, it is possible to achieve reliable and safe endoscopic outpatient management of this disease entity, with resumption of a normal diet on the same day. Methods: We reviewed the physiologic basis, instrumentation, and technical considerations for this endoscopic procedure. We also documented our operat ive experience with 21 patients treated over an Is-month period. Results: Successful minimally invasive management of Zenker's diverticulum was possible in 18 of 21 patients. In two patients, anatomic limitations of mouth and neck anatomy precluded exposure of the diverticulum; in another patient, the diverticulum was too small. Small operative perforations of th e apex of the diverticulum occurred in three cases. Two of these perforatio ns were repaired primarily with minimally invasive techniques; in the other case, treatment consisted of observation alone. In all but this last patie nt, oral diet was resumed on the day of the operation. Eleven of the patien ts were discharged from the hospital on the same day; the remaining patient s went home the following morning. Conclusions: With proper patient selection, minimally invasive management o f Zenker's diverticulum is a safe and effective surgical technique that all ows for outpatient management of the majority of patients who present with this disease.