Surgical therapy of Zenker's diverticulum: Low risk and high efficiency

Barthlen, Winfried; Feußner, H.; Hannig, C; Hölscher, A. H.; Siewert, J. R.

doi:10.1007/bf02407389

Cited by 52 publications

(27 citation statements)

References 19 publications

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“…As previously published [32], functional results were excellent in 82%, and improved in 18% of cases.…”

Section: Zenker's Diverticulumsupporting

confidence: 70%

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The surgical management of motility disorders

Feußner¹,

Kauer²,

Siewert³

1993

Dysphagia

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Surgical treatment is either the therapy of choice or a facultative procedure in various types of esophageal motility disorders. In achalasia, cardiomyotomy, frequently combined with fundoplasty, achieves good or excellent results in > 80% of cases, and is, therefore, advised in cases when pneumostatic dilatation fails. Diverticulectomy and myotomy of the upper or lower esophageal sphincter are proven procedures to treat cervical and epiphrenic diverticula, leading to good/excellent results or at least an improvement in more than 95%. If, exceptionally, parabronchial diverticula require therapy, they should be excised transthoracically. Cervical myotomy is indicated in cases of cervical achalasia, when sufficient pharyngeal propulsion is preserved. In systemic diseases like scleroderma reflux induced complications may require surgical intervention in medically intractable cases. In these rather few cases, subtotal gastrectomy with a Roux-en-Y anastomosis is advised. In patients suffering from diffuse esophageal spasm or symptomatic "nutcracker" esophagus, extended esophageal myotomy can relieve symptoms. If a clear diagnosis is provided, about 75% of patients will have an improvement of symptoms.

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“…As previously published [32], functional results were excellent in 82%, and improved in 18% of cases.…”

Section: Zenker's Diverticulumsupporting

confidence: 70%

“…Additionally, we always perform a myotomy of the upper esophageal sphincter (UES) as does the majority of centers worldwide [32][33][34][35][36] (Fig. 4A and B).…”

Section: Zenker's Diverticulummentioning

confidence: 99%

The surgical management of motility disorders

Feußner¹,

Kauer²,

Siewert³

1993

Dysphagia

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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%

Surgical Treatment of Zenker's Diverticulum

Yao¹,

Zhao²,

Hu³

et al. 2013

Dig Surg

154

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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“…Die bevorzugte Behandlungsmethode in den USA, anders als in Europa, ist die offene, chirurgische Therapie [1,9,10,19]. Es gibt theoretisch 4 Methoden zur chirurgischen Korrektur eines ZD: [18].…”

Section: Die Chirurgische Behandlungunclassified

Intraluminale Therapie des Zenker-Divertikels

Mulder

Hazel

1999

Chirurg

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A Zenker's diverticulum (ZD) is a posterior diverticulum with its neck proximal to the cricopharyngeal muscle. Patients typically present after the age of 60 with symptoms ranging from weeks to years. The classical treatment in the past was surgical, which is still the case in the US. They treat them in general with open myotomy and diverticulectomy. Since the 1950s ENT physicians treat them with rigid endoscopes and cut the bridge between the ZD and the esophagus. This method is widely used throughout western Europe. However, many symptomatic elderly patients are poor surgical/ENT candidates. In 1995, two groups from Brazil and The Netherlands reported their first results with a gastroscopic treatment, in which the ZD bridge is cut with a precut needle/monopolar forceps. Recently, argon plasma coagulation has also been introduced in this field. All these treatments seem effective. Comparative trials between these approaches are now long overdue, since all these modalities will work in the hands of experienced "Zenker specialists".

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Surgical therapy of Zenker's diverticulum: Low risk and high efficiency

Cited by 52 publications

References 19 publications

The surgical management of motility disorders

The surgical management of motility disorders

Surgical Treatment of Zenker's Diverticulum

Intraluminale Therapie des Zenker-Divertikels

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