When is surgery indicated for Zenker diverticulum?

Updated: Oct 16, 2020
  • Author: Joel A Ernster, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

There are a variety of approaches in managing patients with Zenker diverticulum. Familiarity by the treating surgeon with all approaches will allow for optimal decision-making for each patient. [20, 21]

Indications for the repair of Zenker diverticulum are broad. The diverticulum can frequently be the etiology for aspiration and pneumonia and should therefore be repaired in patients capable of tolerating the operative procedure. [22]

However, the overall health of people in the generally older population of patients with Zenker diverticulum may not allow a significant surgical undertaking. [23] Recognition of this problem is essential in designing the ideal treatment plan. However, the range of effective treatment options allows treatment for essentially all symptomatic patients.

From an anatomic perspective, the most common open procedure (diverticulectomy with CP myotomy) has no contraindications. The endoscopic approach (diverticulotomy) may not be performed if the patient has significantly reduced cervical extension or marked trismus.

With regard to improvement of dysphagia and regurgitation, a literature review by Howell et al did not find that open transcervical diverticulectomy for Zenker diverticula was superior to endoscopic laser diverticulectomy or endoscopic stapler-assisted diverticulectomy. [24]


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