Surgical treatment of hypopharyngeal diverticulum (Zenker's diverticulum)

The goal of this study was to evaluate the outcome of various modalities in the treatment of hypopharyngeal diverticulum (Zenker's diverticulum, HD) as performed in the ENT department, University of Ulm. A retrospective analysis of 40 consecutive patients with the diagnosis of a HD was conducted. The three different modalities of surgery applied had been endoscopic laser diverticulotomy (ELD), conventional endoscopic esophagodiverticulotomy (CEE) and transcervical open technique involving diverticulectomy and cricopharyngeal myotomy. Medical records had been reviewed to determine preoperative symptoms and diagnostic findings, operative time, length of hospital stay, time of oral intake, postoperative laboratory parameters, and postoperative complications. Significant differences (P < 0.05) could be observed between the three surgical groups concerning the postoperative time to oral intake, the length of the hospital stay, and the length of time with a nasogastric tube. Patients after ELD had statistically significantly less thoracic pain than patients after CEE. In conclusion, the comparison of three different surgical approaches in the treatment of HD showed that endoscopic techniques versus open-neck technique result in statistically significant shorter operative times and shorter hospital stays. Conventional endoscopic diverticulotomy is not safer than ELD or transcollar open technique.