Cervical esophageal web associated with Zenker's diverticulum

We reviewed 12 patients who underwent diverticulectomy and myotomy for Zenker's diverticulum. Fifty percent of these patients were found to have cervical esophageal webs that were resected at operation. The association of Zenker's diverticulum and esophageal webs is new. The present study demonstrates that it is not a rare relationship and that these webs can cause postoperative problems. We utilized the technique of open diverticulectomy and found that it facilitates cricopharyngeal myotomy and allowed intraoperative inspection of the esophageal lumen, thereby patients with coexisting intraesophageal pathologic abnormalities could be identified. This procedure can be performed within very acceptable limits of morbidity, as demonstrated in our study, although it is not recommended for surgeons who do not regularly operate on the esophagus. Surgeons should consider this technical approach to Zenker's diverticulum when the presence of cervical webs is known or suspected preoperatively. Cervical esophageal webs are a potential source of postoperative dysphagia. They should therefore be excised when encountered intraoperatively. The actual incidence of cervical esophageal webs and their potential role in the pathogenesis of cricopharyngeal muscle hypertrophy and Zenker's diverticulum will require additional study.