|
1
|
Diehl DL, Mehta MJ, Khalid A, Shafqet MA, Khara HS, Confer B. Flexible endoscopic incisional therapy for Zenker's diverticulum (FEIT-Z) is an effective treatment for surgical failures or non-operative patients. Surg Endosc 2022; 36:8863-8868. [PMID: 35578048 DOI: 10.1007/s00464-022-09318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Symptomatic Zenker's diverticulum (ZD) occurs mostly in the elderly, who often have significant comorbidities, and poor neck hyperextension, putting them at high risk for surgical management while also increasing the potential of technical failure. Flexible endoscopic incisional therapy for Zenker's diverticulum (FEIT-Z) offers a safe approach to this problem with high technical and clinical success rates. There are limited data on its use following a failed surgical approach or in patients unfit for a surgical approach. The aim of this study was to assess clinical and technical outcomes of FEIT-Z in patients who were non-operative candidates or refused or failed surgical management. METHODS Patients who underwent FEIT-Z from January 2015 to February 2019 at a tertiary referral center were included. Patient demographics, prior ZD surgical history, procedural data, dysphagia scores, clinical success, and adverse events (AE) were collected. Univariable analysis was performed to assess differences between pre- and post-FEIT-Z dysphagia scores. RESULTS 30 patients undergoing FEIT-Z were included. Seven had a prior failed ZD surgical approach, 6 refused surgical management, and 17 were deemed to be non-operative candidates based on medical comorbidities. Mean age was 78.4 (± 12.1) and 36.7% were male. Technical success of FEIT-Z was 96.7%. There was a significant improvement in dysphagia scores after FEIT-Z: 2.3 (± 0.64) vs. before, 0.4 (± 0.76) (p < 0.001). Long-term clinical success was achieved in 73.3% of patients. Adverse events were seen in 23.3% of patients; however, these were graded as mild in 85.7% of patients. One microperforation was managed with antibiotics. CONCLUSION FEIT-Z is a safe procedure with low adverse events and a high rate of technical and clinical success. FEIT-Z can be done in patients who fail previous surgical treatment, refuse a surgical approach, or are not surgical candidates due to medical comorbidity or other factors.
Collapse
Affiliation(s)
- David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Ave., MC 21-11, Danville, PA, 17822, USA.
| | - Minesh J Mehta
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Ave., MC 21-11, Danville, PA, 17822, USA
| | - Ammara Khalid
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Ave., MC 21-11, Danville, PA, 17822, USA
| | - Muhammad A Shafqet
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Ave., MC 21-11, Danville, PA, 17822, USA
| | - Harshit S Khara
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Ave., MC 21-11, Danville, PA, 17822, USA
| | - Bradley Confer
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Ave., MC 21-11, Danville, PA, 17822, USA
| |
Collapse
|
|
2
|
Sir Charles Bell: Unheralded laryngologist. Am J Otolaryngol 2017; 38:492-495. [PMID: 28528730 DOI: 10.1016/j.amjoto.2017.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sir Charles Bell is renowned and revered as an outstanding surgeon, anatomist, clinician and teacher and his many contributions to various medical fields have been amply described. What are less well-known are his contributions to the field of laryngology. METHODS Selected clinical and physiological publications by Bell were examined that addressed issues related specifically to the airway or pharynx. These included both case reports and case series. RESULTS Bell was keenly interested in the physiology of voice production, disorders of the airways and deglutition. Despite a busy clinical and teaching practice, he took careful notice of individual cases that highlighted important generalizations regarding care for upper aerodigestive tract disorders that are relevant today. He was also the first to recognize the anatomy and physiology of pharyngoesophageal diverticula that Zenker later made more famous. CONCLUSIONS In addition to his many contributions to neurology, facial nerve anatomy and physiology, Sir Charles Bell was also a keen Laryngologist before the era of subspecialization. Rediscovery and study of his work should make us more appreciative of past clinician-investigators who cast a wide net to advance knowledge rather than burrow into a narrow tunnel of vision.
Collapse
|
|
3
|
Revision endoscopic stapler Zenker's diverticulotomy. Surg Endosc 2015; 30:2022-5. [PMID: 26194259 DOI: 10.1007/s00464-015-4435-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Endoscopic stapler diverticulotomy (ESD) has become an accepted primary treatment for Zenker's diverticulum (ZD). Recurrence of symptoms after surgical treatment of ZD is not uncommon, and traditionally patients with recurrent symptomatic ZD were referred to revision surgery by the transcervical Zenker's diverticulectomy approach. Our objective was to evaluate the technical feasibility, safety and effectiveness of revision endoscopic stapler diverticulotomy (RESD) for recurrent ZD. METHODS A case series with chart review study conducted in a tertiary referral center. The records of all patients who underwent ESD at our institute between 2002 and 2013 were retrieved and those who underwent RESD were identified and screened for primary surgical history, symptoms of recurrent ZD, time to recurrence, intraoperative and postoperative RESD course, complications and symptom resolution. The surgical history and outcome results of RESD and primary ESD (PESD) patients were compared. RESULTS Eighty-nine ESDs were performed. Twenty were RESDs for recurrent ZD, and 69 were PESDs. Nine RESDs were performed for recurrent ZD after transcervical Zenker's diverticulectomy, 10 RESDs for recurrent ZD after ESD, and one initial surgical approach was unknown. The mean time from first operation for ZD to RESD was 4.7 years. The average RESD surgery time and hospital stay were 21.4 min and 2.8 days, respectively. Endoscopic stapling of the ZD was feasible in 19 of 20 RESDs. Relief of symptoms without recurrence was achieved after 18 RESDs. Four RESD patients experienced minor postoperative complications. There were no significant differences in operative time, technical feasibility, hospital stay and complication rate between the RESD and PESD groups (P > .05). CONCLUSION RESD for ZD is technically feasible, safe and effective. The results are comparable to those of PESD.
Collapse
|
|
4
|
Hillel AT, Flint PW. Evolution of endoscopic surgical therapy for Zenker's diverticulum. Laryngoscope 2009; 119:39-44. [DOI: 10.1002/lary.20019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
|
5
|
Ribeiro GBS, Mielke F, Volkweis BS, Schirmer CC, Kruel CDP, Morellato G, Binato M, Gurski RR. Tratamento cirúrgico do divertículo de Zenker. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2008. [DOI: 10.1590/s0102-67202008000300003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
RACIONAL: O tratamento cirúrgico do divertículo de Zenker inclui na maioria dos casos a cricomiotomia do músculo cricofaríngeo, a qual pode ser associada à diverticulopexia ou diverticulectomia. A escolha destas opções cirúrgicas ainda é controversa. OBJETIVO: Avaliar os resultados de dois tratamentos cirúrgicos (diverticulopexia ou diverticulectomia, ambos associados à cricomiotomia) em uma série de casos. MÉTODOS: Estudo retrospectivo em período de 10 anos de 26 pacientes submetidos ao tratamento cirúrgico do divertículo de Zenker. Para análise estatística, os pacientes foram divididos em dois grupos: Grupo 1 - diverticulectomia (n=17) e Grupo 2 - diverticulopexia (n=9). Em todos realizou-se miotomia. Foram avaliadas as variáveis: tempo cirúrgico, de internação e de início da alimentação via oral, complicações gerais, ocorrência de fístulas, recidiva dos sintomas e mortalidade. Consideraram-se diferenças significativas quando P<0.05. RESULTADOS: A idade média dos pacientes foi de 64 anos. Sintomas pré-operatórios principais: disfagia (91%) e regurgitação (46%). Todos foram investigados com estudo radiográfico contrastado de faringe-esôfago-estômago e 58% dos casos com endoscopia digestiva alta. Não houve diferença significativa entre os Grupos 1 e 2 em relação ao tempo operatório (96 x 99 min), tempo de internação (5,5 x 5 dias), início da alimentação via oral (7,5 x 4 dias), ocorrência de fístulas esôfago-cutâneas (35 x 22%), recidiva da disfagia (6 x 11%), complicações pós-operatórias em geral (41 x 33%) e tempo de seguimento (7,5 x 9 meses). A mortalidade foi nula. CONCLUSÃO: O tratamento cirúrgico do divertículo de Zenker é método terapêutico relativamente seguro, com morbidade aceitável e seus resultados independem da opção por ressecção ou pexia do divertículo.
Collapse
|
|
6
|
Bonavina L, Bona D, Abraham M, Saino G, Abate E. Long-term results of endosurgical and open surgical approach for Zenker diverticulum. World J Gastroenterol 2007; 13:2586-9. [PMID: 17552006 PMCID: PMC4146819 DOI: 10.3748/wjg.v13.i18.2586] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum.
METHODS: Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years.
RESULTS: The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3 cm).
CONCLUSION: Both operations relieve the outflow obstruction at the pharyngoesophageal junction, indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach. Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter.
Collapse
Affiliation(s)
- Luigi Bonavina
- University of Milano, Department of Medical and Surgical Sciences, Section of General Surgery, IRCCS Policlinico, San Donato, Italy.
| | | | | | | | | |
Collapse
|
|
7
|
Miller FR, Bartley J, Otto RA. The endoscopic management of Zenker diverticulum: CO2 laser versus endoscopic stapling. Laryngoscope 2006; 116:1608-11. [PMID: 16954989 DOI: 10.1097/01.mlg.0000233508.06499.41] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this project was to analyze the endoscopic management of Zenker diverticulum (ZD) using both the CO2 laser and endoscopic stapling techniques. This study compares the two techniques in terms of diverticulum size, onset to oral intake, hospital stay, resolution of symptoms (dysphagia and regurgitation), and complications. STUDY DESIGN A retrospective consecutive case series was performed at an academic medical center. METHODS Forty patients underwent an attempted endoscopic resection of the ZD using either the CO2 laser or the endoscopic stapling technique. The two techniques were compared on a variety of parameters, including diverticulum size, hospital stay, onset to oral intake, resolution of symptoms, and complications. Symptom scores were obtained before and after surgery with a patient self-reported scoring report (scale 0-3 for both dysphagia and regurgitation with 0 indicating asymptomatic and 3 severe symptoms). RESULTS Forty patients underwent an attempted endoscopic management of ZD. Five patients (12.5%) failed endoscopic exposure (four converted to open, one observed). Sixteen patients underwent CO2 laser management and 19 underwent endoscopic stapling. The mean diverticulum size (3.8 cm CO2 laser versus 4.4 cm stapling) was not significantly different for the two groups. Both groups demonstrated a significant decrease in preoperative versus postoperative dysphagia and regurgitation symptoms scores, respectively, CO2 laser dysphagia scores decreasing from 2.75 to 1.38 and the regurgitation score dropping from 1.51 to 0.68, whereas endoscopic stapling dysphagia score decreased from 2.74 to 1.21 and the regurgitation score dropped from 1.37 to 0.53. Overall, 86% of patients demonstrated an onset of liquid intake on postoperative day 1 and the average length of stay was 3.4 days in the CO2 laser group and 1.5 days in the endoscopic stapling (P < .0015). Complications included dental trauma in four patients (two CO2 laser and two stapling) and subcutaneous air in three patients (all three CO2 laser). There were no cases of mediastinitis, recurrent laryngeal nerve injury, fistula, or perioperative death. CONCLUSIONS The endoscopic management of ZD is a safe and effective technique. The endoscopic stapling technique appears to have an improved efficacy and safety when compared with the CO2 laser technique. The two techniques are compared and contrasted.
Collapse
Affiliation(s)
- Frank R Miller
- Department of Otolaryngology-Head Neck Surgery, University of Texas Health Science Center, San Antonio, Texas, USA.
| | | | | |
Collapse
|
|
8
|
Abstract
Cricopharyngeal spasm and Zenker's diverticulum represent disorders of the pharyngoesophageal junction for which a unifying theory of etiology has yet to be established. There is, however, a large body of evidence that supports an association with gastroesophageal reflux. Cricopharyngeal myotomy is the key to successful management of both disorders. Newer transoral endoscopic techniques of management have a lower overall morbidity than traditional open approaches in appropriately selected patients and are therefore gaining popularity as the preferred method of treatment.
Collapse
Affiliation(s)
- Elizabeth A Veenker
- Oregon Health and Sciences University, Department of Otolaryngology/Head and Neck Surgery, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97201-3098, USA
| | | | | |
Collapse
|
|
9
|
[Plea in favour of external cervicotomy approach of Zenker's diverticulum: 73 cases reported]. ANNALES DE CHIRURGIE 2003; 128:167-72. [PMID: 12821083 DOI: 10.1016/s0003-3944(03)00051-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Zenker's diverticulum can be treated surgically or endoscopically. The aim of this study was to assess results of surgical approach with cervicotomy and diverticulectomy. PATIENTS AND METHODS We retrospectively studied the data of 73 patients (50 men and 23 women; mean age, 69 ans; extrêmes: 43-98) consecutively operated on for a Zenker's diverticulum between 1987 and 2000. Surgical procedure included diverticulectomy associated with a large myotomy and oesophageal calibration. Both early and long-term results were compared with those of published series of patients treated by stapled esophagodiverticulostomy. RESULTS Clinical manifestations were: dysphagia (97%), regurgitations (76%), aspirations (45%), weight loss (28%), lung infection (21%), or halitosis (3%). No patient died postoperatively. The early morbidity rate was 4% (3 patients). The mean delay for return of oral feeding and the mean length of hospital stay were respectively 6 and 8 days. At follow-up (mean follow-up, 6 years; extremes: 3 months-13 years), 72 patients (99%) were satisfied and 1 patient felt partially improved. Analysis of published results of series of endoscopic treatment revealed shorter lengths of hospital stay but less favourable long-term results. CONCLUSIONS Early morbidity of surgical treatment of Zenker's diverticulum is low. Long term functional results could be better after surgical diverticulectomy with myotomy than after endoscopic stapled esophagodiverticulostomy.
Collapse
|
|
10
|
Gutschow CA, Hamoir M, Rombaux P, Otte JB, Goncette L, Collard JM. Management of pharyngoesophageal (Zenker's) diverticulum: which technique? Ann Thorac Surg 2002; 74:1677-82; discussion 1682-3. [PMID: 12440629 DOI: 10.1016/s0003-4975(02)03931-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Incomplete symptomatic relief of pharyngoesophageal (Zenker's) diverticulum after endoscopic stapling or laser division has been reported by some authors. The clinical relevance of cricomyotomy, although supported by experimental data, remains controversial. METHODS Operative procedures consisted of transcervical resection (n = 34, group I), transcervical resection plus cricomyotomy (n = 12, group II), transcervical cricomyotomy (n = 8, group III), transcervical cricomyotomy plus diverticulopexy (n = 47, group IV), endoscopic stapling division (n = 31, group V), and endoscopic laser division (n = 55; group VI). RESULTS The percentage of totally asymptomatic patients was significantly (p < 0.004) higher after open procedures (combined groups I to IV) than after endoscopic treatment (combined groups V and VI) regardless of the size of the pouch (< 3 cm, 85% versus 25%; > or = 3 cm, 86% versus 50%). The percentage of patients with no or occasional (ie, fewer than twice a week) symptoms was significantly (p < 0.001) higher after open procedures (98%) than after endoscopic treatment (57%) for less than 3-cm diverticula whereas it was not higher (p = 0.409) for 3-cm or greater pouches (open, 97%; endoscopic, 88%). Furthermore, this percentage was similar (p > 0.286) after endoscopic stapling division and after endoscopic laser division (< 3 cm, 50% versus 58%; > or = 3 cm, 96% versus 80%). It was also similar (p > 0.197) after resection alone (group I) and after open operations including myotomy (combined groups II to IV) (< 3 cm, 100% versus 98%; > or = 3 cm, 92% versus 100%). Unlike endoscopic stapling and division, laser division was complicated by mediastinitis (2 patients), and 1 patient was referred because of cervical esophageal disruption during laser division. Five of six postoperative fistulas after resection occurred in patients who did not have myotomy, and 4 patients were referred 12 to 49 years after resection without myotomy for true recurrence of the pouch. CONCLUSIONS Open techniques afford better symptomatic relief than endoscopic techniques, especially in patients with small diverticula. Endoscopic stapling and division is safer than laser division. Although very effective at midterm, resection without myotomy predisposes to the development of postoperative fistula and to recurrence of the pouch after many years.
Collapse
|
|
11
|
Adams J, Sheppard B, Andersen P, Myers B, Deveney C, Everts E, Cohen J. Zenker's diverticulostomy with cricopharyngeal myotomy: the endoscopic approach. Surg Endosc 2001; 15:34-7. [PMID: 11178758 DOI: 10.1007/s004640000323] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The gold standard for the surgical treatment of Zenker's diverticulum is diverticulectomy and cricopharyngeal myotomy by an external approach. Unfortunately, many of the patients who present with this entity are elderly and have significant comorbidities that increase operative risk. Traditional minimally invasive approaches have not met with widespread success. However, by combining the exposure afforded by the otolaryngologist's newer bivalved operating laryngoscopes with the operative techniques made possible by the general surgeon's laparoscopic instrumentation and staplers, it is possible to achieve reliable and safe endoscopic outpatient management of this disease entity, with resumption of a normal diet on the same day. METHODS We reviewed the physiologic basis, instrumentation, and technical considerations for this endoscopic procedure. We also documented our operative experience with 21 patients treated over an 18-month period. RESULTS Successful minimally invasive management of Zenker's diverticulum was possible in 18 of 21 patients. In two patients, anatomic limitations of mouth and neck anatomy precluded exposure of the diverticulum; in another patient, the diverticulum was too small. Small operative perforations of the apex of the diverticulum occurred in three cases. Two of these perforations were repaired primarily with minimally invasive techniques; in the other case, treatment consisted of observation alone. In all but this last patient, oral diet was resumed on the day of the operation. Eleven of the patients were discharged from the hospital on the same day; the remaining patients went home the following morning. CONCLUSIONS With proper patient selection, minimally invasive management of Zenker's diverticulum is a safe and effective surgical technique that allows for outpatient management of the majority of patients who present with this disease.
Collapse
Affiliation(s)
- J Adams
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA
| | | | | | | | | | | | | |
Collapse
|
|
12
|
Scher RL, Richtsmeier WJ. Endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum. Laryngoscope 1996; 106:951-6. [PMID: 8699907 DOI: 10.1097/00005537-199608000-00007] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We have used a new technique, endoscopic staple-assisted esophagodiverticulostomy (ESED), for the treatment of Zenker's diverticulum. This technique is a modification of the endoscopic approach first described by Mosher in 1917 and popularized by Dohlman and Mattsson in which the common wall between the esophagus and diverticulum was divided without mucosal closure. ESED differs in that an endosurgical stapler is used to create an esophagodiverticulostomy by dividing the common wall between the esophagus and diverticulum, with the mucosal and muscular edges sealed by the staples. We have performed this procedure in six patients, with no perioperative morbidity in any patient. All patients resumed oral intake on either the first or second postoperative day, with no evidence of fistula formation or mediastinitis. Hospital stay has averaged 2 days (range, 1 to 3 days). Patient follow-up after ESED averages 6 months and is available for five of the six patients treated. There has been complete resolution of pretreatment symptoms in these five patients, with resumption of regular diet between postoperative day 3 and day 14 (average, day 9). Our results demonstrate that ESED is a safe and effective treatment for Zenker's diverticulum. This endoscopic approach offers a number of advantages over previously used treatments for Zenker's diverticulum, including reduced morbidity, rapid convalescence, short hospitalization, brief operative time, and predictable resolution of symptoms.
Collapse
Affiliation(s)
- R L Scher
- Department of Surgery, Duke University Medical Center, Durham, N.C. 27710, USA
| | | |
Collapse
|
|
13
|
Westrin KM, Ergün S, Carlsöö B. Zenker's diverticulum--a historical review and trends in therapy. Acta Otolaryngol 1996; 116:351-60. [PMID: 8790732 DOI: 10.3109/00016489609137857] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
More than 200 years have passed since the pulsion diverticulum of hypopharynx was first described. This paper reviews different opinions on its etiology over the centuries. The German pathologist F.A. von Zenker, who successfully pursued research on a variety of topics, is often associated with this diverticulum through his classical work from 1867 "Krankheiten des Oesophagus", which deals with the pathogenesis and clinical presentations of this herniation of the posterior mucosal wall. Numerous surgical techniques, which have been practised mainly during this century, are also reviewed. Different options of endoscopic surgery, which is presently the preferred approach at many medical centers, are described and discussed. Our own experience of endoscopic surgery in patients with Zenker's diverticulum is also presented.
Collapse
Affiliation(s)
- K M Westrin
- Department of Oto-Rhino-Laryngology, Karolinska Institute, Huddinge University Hospital, Sweden
| | | | | |
Collapse
|
|
14
|
Collard JM, Otte JB, Kestens PJ. Endoscopic stapling technique of esophagodiverticulostomy for Zenker's diverticulum. Ann Thorac Surg 1993; 56:573-6. [PMID: 8379739 DOI: 10.1016/0003-4975(93)90906-x] [Citation(s) in RCA: 164] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We present an endoscopic technique of division of the common wall between the esophagus and the hypopharyngeal (Zenker's) diverticulum. The novelty of the technique, as compared with endoscopic sutureless coagulating methods, consists of stapling the esophageal to the diverticular wall using the Endo-GIA 30 stapler (US Surgical Corp, Norwalk, CT), which protects the neck from any contamination from the digestive lumen and ensures optimal hemostasis of the wound edges. The stapler has been designed such that perforation of the bottom of the diverticulum is not likely. The technique has been applied to 6 patients.
Collapse
Affiliation(s)
- J M Collard
- Department of Surgery, Louvain Medical School, Brussels, Belgium
| | | | | |
Collapse
|
|
15
|
Santovin KK, Conlon SW, Campbell AD, Ferrara BE. Zenker's Diverticulum. AORN J 1993. [DOI: 10.1016/s0001-2092(07)68421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|