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Technical Considerations and Approach to Redo Foregut Surgery
Published on: September 22, 2023
Endoscopic Zenker's diverticulotomy (Dohlman procedure): forty cases reviewed
1Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California, USA.
Summary
Endoscopic diverticulotomy offers a safe and effective treatment for pharyngoesophageal diverticula. This minimally invasive procedure successfully treated 37 of 40 patients, even those with comorbidities.
Area of Science:
- Gastroenterology
- Otolaryngology
- Surgical Innovation
Background:
- Pharyngoesophageal diverticula arise from a natural weakness in the pharyngeal wall.
- Cricopharyngeus muscle dysfunction is the likely cause of these acquired pouches.
- Treatment focuses on addressing sphincter dysfunction and managing the diverticulum.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic diverticulotomy for pharyngoesophageal diverticula.
- To assess outcomes in patients with comorbidities undergoing this procedure.
Main Methods:
- Retrospective review of 40 patients undergoing endoscopic diverticulotomy.
- Procedure involves dividing the cricopharyngeus muscle and the common wall between the esophagus and diverticulum.
- Patient data included age, diverticula size, surgery time, hospital stay, and complications.
Main Results:
- Mean diverticula size: 4.1 cm; mean surgery time: 41 minutes; mean hospital stay: 4.5 days.
- 37 of 40 patients achieved a regular diet, reported no regurgitation, and were satisfied.
- Complications included pneumomediastinum, UTIs, URIs, and lip laceration.
Conclusions:
- Endoscopic diverticulotomy is a safe, expedient, and effective treatment for pharyngoesophageal diverticula.
- The technique is particularly suitable for patients with significant comorbidities.
- Outcomes compare favorably with traditional external surgical approaches.
