Outcome analysis of Zenker's diverticulectomy and cricopharyngeal myotomy

Witterick, Ian J.; Gullane, Patrick; Yeung, Eugene

doi:10.1002/hed.2880170504

Cited by 47 publications

(33 citation statements)

References 21 publications

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“…Because the disease usually affects elderly patients with potential cardiopulmonary comorbidity, this condition predisposes postoperative systemic complications, and this fact was present in 8.7% of the patients in our series and was similar in others [3,4,7,11,17,24]. Smoking is another relevant factor, because all of the patients who presented this complication were long term smokers.…”

Section: Discussionsupporting

confidence: 86%

“…The treatment of this disease is fundamentally surgical, being based on its etiopathogenesis in such way that most authors have been practicing diverticulectomy followed by myotomy of the cricopharyngeal muscle [3,[14][15][16][17]. Other authors have been practicing diverticulopexy, associated with cricopharyngeal myotomy, demonstrating similar results when compared with diverticulectomy and myotomy [4,11,18].…”

Section: Discussionmentioning

confidence: 99%

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Early and late assessment of the surgical treatment of the pharyngoesophageal diverticulum by mechanical and manual suture

Aquino¹,

Chagas²,

Said³

et al. 2017

Otorhinolaryngol Head Neck Sur

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Rationale: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea to accomplish this surgical procedure, to compare the manual and mechanical suture in order to evaluate the actual benefit of the mechanical technique. Objectives:The objective of this study is to retrospectively evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture in a series of patients with regard to local and systemic complications.Method: 57 patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (Group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (Group B). Results:In the postoperative period, one patient of Group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of Group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, 3 patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from Group A presented such complication. Lung infection was present in five patients, being two (8.3%) of Group A and three (9.0%) of Group B, having good outcomes after specific treatment. In the late review, done with 18 patients (75.0%) of Group A and 25 (75.7%) of Group B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion:The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual suture, because it provided a lower index of local post-surgical complications.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Early and late assessment of the surgical treatment of the pharyngoesophageal diverticulum by mechanical and manual suture

Aquino¹,

Chagas²,

Said³

et al. 2017

Otorhinolaryngol Head Neck Sur

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“…Witterick et al 25 realizaram a diverticulectomia e miotomia do cricofaríngeo em 18 pacientes com DZ e fizeram estudos radiológicos contrastados de controle cerca de 30 meses após, constatando recidiva de pequenos divertículos em 8 deles (44%), que mantinham-se assintomáticos.…”

Section: Discussionunclassified

Tratamento cirúrgico do divertículo de Zenker: diverticulopexia versus diverticulectomia

Aandreollo¹,

Lopes²,

Brandalise³

et al. 2007

ABCD, arq. bras. cir. dig.

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InTRODUÇÃODivertículo faringoesofágico, descrito inicialmente por Ludlow (1769) 19 , ou divertículo de pulsão, por Zenker (1877) 26 , é herniação adquirida na mucosa faríngea através de um defeito muscular entre as fibras oblíquas do músculo constritor inferior da faringe e as transversas do músculo cricofaríngeo. Nesta localização, há área triangular bem delimitada, denominada de triângulo de Killian, na qual as fibras musculares estão rarefeitas, deixando exposta a mucosa da hipofaringe. A mucosa herniando através desta área vai formar o divertículo de Zenker (DZ) de variados tamanhos 8 .A ocorrência do DZ é muito variável, sendo mais freqüentemente encontrado no norte da Europa. Não é raro na América do Norte e Austrália, mas muito incomum no Japão e Indonésia. Não há relatos sobre sua freqüência na América do Sul e Brasil, contudo é considerado como de ocorrência pouco freqüente. A sua ocorrência entre ABCDDV/568Andreollo NA, Lopes LR, Brandalise NA, Camargo MA, Coelho-Neto JS. Tratamento cirúrgico do divertículo de Zenker: diverticulopexia versus diverticulectomia. ABCD Arq Bras Cir Dig 2007;20(4):245-9. RESUMO -Racional -Divertículo faringoesofágico, conhecido como de Zenker, é herniação adquirida na mucosa faríngea através de um defeito muscular entre as fibras oblíquas do músculo constritor inferior da faringe e as transversas do músculo cricofaríngeo. Objetivo -estudo retrospectivo, não randomizado, compararando os resultados da diverticulopexia e diverticulectomia, ambas associadas à miotomia do músculo cricofaríngeo, no tratamento do divertículo de Zenker. os doentes com disfagia é de 1 a 3%, mais comum na faixa etária entre 60 e 90 anos, e predominante no sexo masculino (2:1) 5 .Muitas teorias foram lançadas ao longo dos anos sobre a sua etiopatogenia, porém, nenhuma delas tem sido totalmente aceita, apesar de estudos detalhados com manometria e cinerradiografia. A maioria dos autores concorda que a seu aparecimento é secundário à obstrução funcional e aumento da pressão intraluminal ao nível do músculo cricofaríngeo, ou seja decorrente de incoordenação entre as contrações da faringe e o relaxamento do esfíncter esofágico superior. Caracteriza-se por ter evolução progressiva ao longo dos anos 4,5,24 .Os sintomas mais freqüentes incluem disfagia referida na região cervical, regurgitação, halitose, tosse à ingestão alimentar e aspiração pulmonar. Ocasionalmente os pacientes poderão apresentar emagrecimento importante, chegando à desnutrição grave e com pneumonias de repetição. O diagnóstico é estabelecido mediante história clínica minuciosa, radiografias contrastadas da faringe e esôfago, endoscopia digestiva alta, e eventualmente utilizando a manometria e a cinerradiografia 2,20 . Entre as complicações é citada a sua perfuração, considerada muito

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“…En los pacientes con divertículo de Zenker la técnica quirúrgica abierta clásicamente realizada corresponde a una diverticulectomía a través de una cervicotomía lateral izquierda con miotomía cricofaríngea cuyos resultados han exhibido tasas de resolución de los síntomas superior a un 90% 45,[48][49][50][51][52] . Las complicaciones varían entre un 10 a un 30%, asociándose a una mortalidad mínima [45][46][47][48][49][50][51][52][53] .…”

Section: Patología Diverticular Del Esófagounclassified

“…Las complicaciones varían entre un 10 a un 30%, asociándose a una mortalidad mínima [45][46][47][48][49][50][51][52][53] . La cirugía mínimamente invasiva se ha planteado como una alternativa para el enfrentamiento terapéutico de esta patología.…”

Section: Patología Diverticular Del Esófagounclassified

Resultados del tratamiento quirúrgico de la patología esofágica benigna con cirugía mínimamente invasiva: Experiencia en 483 pacientes

et al. 2013

Rev Chil Cir

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Minimally invasive surgery for benign esophageal diseases. Experience in 483 patientsBackground: Minimally invasive surgical techniques are increasingly used for the treatment of benign esophageal diseases. Aim: To report the results of minimally invasive surgical techniques among patients with benign esophageal diseases. Material and Methods: Four hundred eighty three patients aged 37 to 81 years (184 males), were studied. Of these, 278 had a Barret esophagus, 125 had a hiatal hernia, 75 had achalasia and five had esophageal diverticula. All patients were studied using standard protocols, operated using minimally invasive techniques and followed, registering postoperative complications and recurrence of symptoms. Results: Among patients with esophageal reflux, 85% had successful results on the long term. Among patients with hiatal hernia and subjected to laparoscopic surgery, 12% had complications and 12% had recurrence of symptoms which increased to 17% if a mesh was not used. The recurrence rate among patients with achalasia is less than 5%. There was no recurrence among patients with esophageal diverticula. Conclusions: Minimally invasive surgery for esophageal diseases has good success rates, with a lower incidence of complications than open surgery.

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Outcome analysis of Zenker's diverticulectomy and cricopharyngeal myotomy

Cited by 47 publications

References 21 publications

Early and late assessment of the surgical treatment of the pharyngoesophageal diverticulum by mechanical and manual suture

Early and late assessment of the surgical treatment of the pharyngoesophageal diverticulum by mechanical and manual suture

Tratamento cirúrgico do divertículo de Zenker: diverticulopexia versus diverticulectomia

Resultados del tratamiento quirúrgico de la patología esofágica benigna con cirugía mínimamente invasiva: Experiencia en 483 pacientes

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