Surgical Treatment of Zenker's Diverticulum

Abstract

Background: Different surgical techniques have been indicated for the management of Zenker's diverticulum (ZD), including diverticulectomy, diverticulopexy, and diverticular inversion, with or without myotomy, and myotomy alone. More recently, minimally invasive techniques (such as the transoral endoscopic approach) have become increasingly reliable for this disorder. We therefore conducted this systematic review in order to gain a profound understanding of the current trend and evidence in surgical management of ZD. Methods: Medline and PubMed were searched to identify studies on surgical intervention of ZD published in English between January 1990 and March 2011. Results: We identified 6,915 patients from 93 studies evaluating the effect of the surgical intervention for ZD. No randomized controlled trials comparing one technique with another were identified. Conclusion: Diverticulectomy with myotomy has become the mainstream treatment option for ZD. In certain selected patients, endoscopic diverticulotomy may offer some advantages over open surgery, such as less trauma and a lower complication rate. It is important to individualize optimal therapy for each patient. More randomized controlled trials with long-term follow-up results are required to draw a valid conclusion on the best surgical intervention modality for ZD.

Nursing approach to Zenker’s diverticulum surgery patient

“…13 Open surgery for Zenker's diverticulum: It is referred to treatment choice of ZD. Routinely, an open left cervical incision is usually performed under general anesthesia.…”

“…Further, the diverticulum is either resected (diverticulectomy), or more conservatively, suspended and fixed on the hypopharyngeal wall (diverticulopexy) or invaginated into esophagus itself (diverticular inversion). 13,15 Endoscopic diverticulotomy: It is described as esophagodiverticulotomy. But this procedure has a high risk of mediastinitis.…”

“…The endoscopic approach can commonly be consunmate two ways as a flexible or a rigid endoscope. 13 Rigid endoscopic diverticulotomy: It is carried out under general anesthesia and patients are placed supine with their neck overextended. A special diverticuloscope is used to visualize and expose the common septum separating the diverticular sac from the esophageal lumen.…”

“…13 Endoscopic CO2 laser technique: It has a lot of advantages. As high energy, high focus beam, and less tissue trauma, rapid healing and mucosal coverage of cut surfaces.…”

“…Also it provides a better visualization of the diverticular bridge and easier control of the operation. 13,15 Endoscopic stapling technique: In the last 10 years, endoscopic stapling technique has become increasingly popular. The technique is consequently not indicated for diverticula smaller than 3 cm.…”