Surgical experience of the national institution in the treatment of Zenker's diverticula

Simić, Aleksandar; Radovanović, Nebojša; Stojakov, Dejan; Bjelović, Miloš; Kotarac, M; Sabljak, Predrag; Skrobić, Ognjan; Peško, P

doi:10.2298/aci0901025s

Cited by 21 publications

(15 citation statements)

References 28 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%

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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%

“…Patients with this disease present dysphagia and regurgitation as main symptoms, and they may also present halitosis and weight loss as secondary symptoms, which affect their life quality significantly [4,6,7].…”

Section: Introductionmentioning

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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“…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,…”

Section: Search Resultsmentioning

confidence: 99%

“…Only the cricopharyngeus, the primary muscle which exerts the physiological function of UES [108], contracts and relaxes during all the physiological states [109]. Theoretically, in order to achieve complete myotomy, except for the cricopharyngeus muscle, the inferior pharyngeal constrictor and cervical esophagus should also be dealt with, but there is no general agreement on the exact length of the myotomy, ranging from 2 to 6 cm [60,62,110]. Comparing ZD patients with healthy controls, Lerut et al [81] demonstrated that cricopharyngeal muscle and cervical esophageal striated muscle have the same pathological changes.…”

Section: Extent Of Myotomymentioning

confidence: 99%

“…A more recent study compared myotomy plus diverticulectomy in 14 patients with myotomy plus diverticulopexy in 36 patients, revealing that diverticulectomy required a longer hospital stay and fasting period. Four out of 36 patients with diverticulopexy and 2 out of 14 patients with diverticulectomy developed recurrence of dysphagia within 6 months, but all of them were spontaneously symptom-free within 1 year after operation [60]. …”

Section: How To Deal With Diverticulummentioning

confidence: 99%

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Surgical Treatment of Zenker's Diverticulum

Yao¹,

Zhao²,

Hu³

et al. 2013

Dig Surg

146

152

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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.

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