Zenker diverticulum: Experience in surgical treatment of large diverticula

Abstract

The purpose of this retrospective study is to show that transcervical diverticulectomy (TD) in treatment of Zenker diverticulum (ZD) can still be a first choice procedure in selected patients and in experienced hands its safety might be compared to the minimally invasive endoscopic diverticulostomy.The study cohort consisted of 44 patients (18 male, 26 female) operated for (ZD). All the patients underwent open diverticulectomy. The decision to choose open surgical repair depended on surgical risk, age of the patient, size of the diverticular septum (the distance between the top of the diverticulum and its bottom on barium study), and patient's preference.Mean age of patients was 64.6 ± 11.9 years; range: 26 to 88 years. A total of 36.4% out of them finished 70 years. Postoperative mortality was nil. Two major complications (4.5%) requiring surgical intervention occurred: leak and hematoma.Data were analyzed by t test for independent samples using Statistica 12.5 software. P value <0.05 was considered statistically significant.Surgical treatment of patients with ZD should be individualized. Large Zenker diverticula with the septum longer than 6 cm should preferably be resected through an open approach because it is not possible to remove the septum completely during one-step endoscopic procedure and diverticulostomy creates a weak and large common cavity in the esophagus. Surgical repair is effective for all sizes of diverticula, but its most serious complications such as leakage or laryngeal nerve injury should be considered, especially in elderly patients with comorbidities. However, age alone should not be the main criterion if choosing the treatment option.

Figure 1

(A, B) Sixty three-years old women with the diverticulum with 15 cm long septum and esophgo-tracheal fistula. The diverticulum was permanently visible even she vomited and emptied it, and mimicked a large goiter. Computed tomography (CT) image of this large diverticulum with visible fistula between the esophagus and the trachea, which is abnormally translocated by the diverticulum permanently filled with air.

Figure 2

(A, B) Contrast radiogram of the esophagus presenting the diverticulum with the septum 12 cm long in the antero-posterior position. The same esophagus 6 months after diverticulectomy and myotomy. Antero-posterior position.