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Zenker's diverticulum: Rotterdam experience.

L J Visser1, J A U Hardillo2, D A Monserez2

  • 1Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands. laurentsvisser@hotmail.com.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|November 19, 2015
PubMed
Summary

Minimally invasive surgery is standard for Zenker's diverticulum (ZD). Stapler-assisted endoscopic cricopharyngeal myotomy offers shorter surgery and hospital stays compared to laser or transcervical approaches, though re-intervention risks exist.

Keywords:
DiverticulumDysphagiaEndoscopyPharynxZenker

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Area of Science:

  • Otolaryngology
  • Gastroenterology
  • Surgical Innovation

Background:

  • Zenker's diverticulum (ZD) management traditionally involved open surgery.
  • Minimally invasive endoscopic techniques have become the standard of care for ZD treatment.
  • Evaluating the efficacy and efficiency of different surgical approaches for ZD is crucial.

Purpose of the Study:

  • To review the experience with Zenker's diverticulum management and treatment.
  • To determine the most effective and efficient treatment modality for ZD.
  • To compare outcomes of endoscopic (stapler, laser) and transcervical approaches for ZD.

Main Methods:

  • Retrospective review of 94 patients treated for ZD between 2004 and 2014.
  • Procedures included endoscopic cricopharyngeal myotomy (stapler and laser) and transcervical approach.
  • Data collected on pre- and intraoperative characteristics, operating time, post-operative admission, symptom resolution, and complications.

Main Results:

  • Stapler endoscopic myotomy had the shortest mean operating time (49.0 min) and median hospital stay (2.0 days).
  • Complete symptom resolution was achieved in 60% of endoscopic cases (57% stapler, 65% laser) and 67% of transcervical cases.
  • Endoscopic treatments resulted in 10 complications (Clavien Dindo G1-G2), while the transcervical approach had 2 severe complications (G3b, G5).

Conclusions:

  • Both endoscopic techniques (stapler and laser) offer efficient Zenker's diverticulum management.
  • Stapler-assisted modality provides shorter surgery duration and hospital admission.
  • While complication and recurrence rates may not differ significantly, stapler patients might face higher risks of re-intervention and more severe complications.