Evolution of surgical treatment for pharyngeal pouch

Aly, Ahmad; Devitt, Peter G.; Jamieson, Glyn G.

doi:10.1002/bjs.4572

Cited by 70 publications

(22 citation statements)

References 69 publications

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“…Suspicion for an abnormal pouch leads to a CT scan of the neck and this subsequently aided surgical planning. Endoscopic diverticulotomy has been a well-accepted approach to surgical management of Zenker's diverticuli for the past two decades; however, Killian-Jamieson and Laimer's diverticula have usually been treated via an external approach [9, 10]. An external approach allowed for careful and accurate identification and dissection of the pouches, with preservation of the neurovascular bundle.…”

Section: Discussionmentioning

confidence: 99%

Atypical Pharyngeal Pouch Arising Bilaterally between the Hyoid Bone and Thyroid Cartilage

Chan

Veivers

2017

Case Reports in Otolaryngology

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Introduction. Pharyngoesophageal diverticuli are a common cause of dysphagia; they are associated with various morbidities and a decreased quality of life. There are several different types of the diverticuli, and they are divided based on the anatomical location of origin relative to the cricopharyngeal muscle; these include Zenker's, Killian-Jamieson's, and Laimer's diverticula. The authors present a unique case of pharyngoesophageal diverticulum that has not been previously described. Case Presentation. A 65-year-old male presented with a 12-month history of dysphagia and odynophagia for solids. Barium swallow revealed bilateral moderately sized diverticuli that altered in size during the different phases of swallow. CT scan of the neck with oral contrast further identified the anatomy of the diverticuli, arising between the hyoid bone and thyroid cartilage. Discussion. An external transcervical approach was utilised to successfully repair the diverticuli. Subsequent cricopharyngeal spasm was treated with botulinum toxin, and the patient recovered with no ongoing symptoms. The barium swallow study is a commonly utilised initial investigation as it is easy to perform and safe and has good diagnostic value. Definitive management usually involves either endoscopic or open surgery. This case depicts a unique case of a pharyngeal diverticulum arising between the hyoid bone and thyroid cartilage.

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Section: Discussionmentioning

confidence: 99%

Atypical Pharyngeal Pouch Arising Bilaterally between the Hyoid Bone and Thyroid Cartilage

Chan

Veivers

2017

Case Reports in Otolaryngology

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“…The great advantage compared to external approach is that endoscopic revision treatment is technically feasible and relatively easy, no more difficult than the primary endoscopic procedure, with no increase of risk. Moreover, patient satisfaction was higher in those who underwent endoscopic revision surgery compared to those who underwent open revision surgery [5, 12, 18]. …”

Section: Discussionmentioning

confidence: 99%

Zenker's Diverticulum: Carbon Dioxide Laser Endoscopic Surgery

Plzák

Zábrodský

Lukeš

2014

BioMed Research International

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Nowadays endoscopic diverticulotomy is the surgical approach of the first choice in treatment of Zenker's diverticulum. We report our experience with this procedure and try to sum up recent recommendations for management of surgery and postoperative care. Data of 34 patients with Zenker's diverticulum, treated by endoscopic carbon dioxide laser diverticulotomy at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic, were prospectively stored and followed in relatively short period from May 2009 to December 2013. The average length of diverticulum was 32 mm. The average duration of surgery was 32 min. The patients were fed via feeding tube for 6.1 days and antibiotics were administered for 7 days. Mean hospitalization time was 7.4 days. We observed one transient recurrent laryngeal nerve paralysis and no other serious complications. Recurrence rate was 3%. We recommend complete transection of the diverticular septum in one procedure, systemic antibiotic treatment and exclusion of transoral intake for minimally 5 days, and contrast oesophagogram before resumption of oral intake to exclude fistula. Open diverticulectomy should be reserved for cases with inadequate endoscopic exposure and for revision surgery for multiple recurrences from endoscopic diverticulotomies.

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“…Die hierzu veröffentlichten Daten sind ebenfalls vielversprechend, wobei die präzise Handhabung einen wichtigen Vorteil darstellt [11,12]. Im Einklang mit der chirurgischen Strategie bei der Therapie des Zenker-Divertikels scheint die komplette Dissektion des M. cricopharyngeus ein positiver prädiktiver Faktor für niedrige Rezidivraten zu sein [1,13] Tendenziell scheint beim Einsatz der Argon-Plasmakoagulation häufiger mehr als eine Therapiesitzung bis zur erfolgreichen Behandlung des Zenker-Divertikels erforderlich zu sein [5,14]. Grundsätzlich sind jedoch sowohl Nadelmesser als auch APC zur vollständigen Inzision des Divertikelstegs in einer einzigen Sitzung geeignet [5,9,10,15].…”

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