Management of Zenker's diverticulum and Postlaryngectomy pseudodiverticulum with the CO₂ laser

Abstract

Dysphagia is a common symptom and can be caused by anterior pharyngeal (pseudodiverticulum after laryngectomy) and posterior pharyngeal (Zenker's) diverticula. The only treatment is surgical. The experience with an endoscopic treatment, especially with the CO(2) laser, is limited. Between 1984 and 1996, 81 patients with dysphagia were treated endoscopically with the CO(2) laser at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Kiel. In 70 patients the swallowing disorder was caused by a hypopharyngeal diverticulum, and in 11 patients it was caused by a pseudodiverticulum after laryngectomy. In the Zenker's group, more than 90% of the patients were treated successfully. Eight of 11 patients with pseudodiverticula were without symptoms, and in the remaining 3 patients dysphagia was improved after laser therapy. The excision technique was superior to the incision procedures. The rate of postoperative complications was generally low. The microendoscopic approach with the CO(2) laser is a recommendable method for the treatment of Zenker's diverticulum and pseudodiverticulum in the postlaryngectomy patient. The surgical technique with the CO(2) laser at low power settings is a less invasive, quick, relatively safe, and effective procedure requiring only short hospitalization.

Carbon Dioxide Laser Endoscopic Diverticulotomy for Zenker’s Diverticulum: Results and Complications in a Consecutive Series of 40 Patients

“…Our case of this severe complication is concurrent with the literature, where inflammation of the mediastinum is also rarely reported [4][5][6][7][8][9][10] . There is common agreement that the small percentage of severe inflammation in disclosed mediastinum is due to the quick readaption of the outer fascia, which will form a secure seal [7] .…”

“…Postoperatively, some authors allow early resumption of oral intake [5,9] . From our experiences, we recommend the start of oral feeding at around the sixth postoperative day, as scar and granulation tissue need 5 days to seal the cut edges [13] .…”

Surgical Treatment of Zenker's Diverticulum

“…We identified 6,915 patients from 93 studies evaluating the effect of the surgical treatment for ZD, including 52 studies [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59] (n = 3,336) on endoscopic surgeries, 22 [60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81] (n = 2,204) on open surgeries, and 19 [3,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,…”

Flexible endoscopic and surgical management of Zenker's diverticulum

“…In 1990, van Overbeek reported a modification of the Dohlman procedure by using a CO 2 laser instead of electrocautery [6]. A few years later two other centers reported their experience ( FigurE 5A-5C) [86,87].…”