Surgical Treatment of Hypopharyngeal (Zenker's) Diverticulum

Comparison of endoscopic diathermy and resection in the surgical treatment of pharyngeal diverticula

“…Excision of diverticula at that time carried a high operative mortality due to sepsis, and consequently Goldman proposed a two-stage operation in 1909 to try to overcome this. The two-stage operation became the treatment of choice, but following the advent of antibiotics this was largely superseded by the one-stage procedure (Boyes-Korkis, 1958;Clagett and Payne, 1960;Bertelsen and Aastad, 1976;Butcher and Larrabee, 1979).…”

Zenker diverticulum: Pathophysiology, Clinical Presentation, and Therapeutic Management

“…Regurgitation of undigested foods, halitosis, and hoarseness can also occur. Cervical borborygmi is almost pathognomonic of ZD [7]. As the pouch enlarges, symptoms become more severe with resultant weight loss and malnutrition.…”

“…A sudden increase in the severity of dysphagia and regurgitation and/or development of alarm symptoms such as local pain and hemoptysis or hematemesis may signal the presence of squamous cell carcinoma within the ZD which has an incidence of 0.4-1.5%. [7] Other pathologies associated with ZD include laryngocoele, leiomyoma, polymyositis, cervical esophageal web, carotid body tumor, anterior cervical fusion, stenosis of upper esophagus, hiatus hernia, and gastroesophageal reflux. These coexisting pathologies are not directly associated with or caused by ZD, but can be additional causes of dysphagia in patients with ZD.…”

“…In most cases, the diagnosis of ZD is suspected based on clinical symptoms and confirmed by esophageal studies. Complications of untreated ZD include retained foreign body, tracheal fistula, vocal cord paralysis, fistula to the prevertebral ligament with cervical osteomyelitis, peptic ulceration, and hemorrhage [7].…”

“…Cricopharyngeal myotomy remains a key element of surgical treatment of Zenker diverticulum (ZD) [2,4]. Although there is a lack of randomized clinical trials, surgeons favor minimally invasive endoscopic techniques -stapling or laser diverticulostomy -because they are believed to cause fewer complications and produce similar outcomes to classic trans-cervical repair [5][6][7][8].…”