[Surgical treatment of pharyngoesophageal or Zenker's diverticulum]

The different surgical approaches of Zenker's diverticulum are controversial.

To analyze the results of the surgical management of Zenker's diverticulum.

The charts of patients with surgical treatment of Zenker's diverticulum were reviewed in a retrospective fashion. The demographic and clinical data, surgical indication and procedures, operative morbidity and mortality and results were analyzed.

There were 15 patients, 12 men and 3 women with an average age of 68 years. All of them reported cervical dysphagia, 93 per cent regurgitation and 60 per cent upper airway symptoms. The barium esophageal study was diagnostic in all patients. Cricopharyngeal myotomy was performed in all patients and diverticulopexy (60 per cent) or diverticulectomy (40 per cent) was accomplished. There were one mucosal perforation during the myotomy but three esophageal fistula were developed during the first postoperative week. All three received medical treatment with healing between the 7th to 21st postoperative day. One patient suffered acute myocardial infarction and there were no deaths. During the follow-up in 14 patients (93.3 per cent) disappearance of symptoms were reported, in the remaining patient minimal dysphagia was present.

The surgical treatment of Zenker's diverticulum should be performed in symptomatic patients. The esophageal X-ray study is the best diagnostic tool. The cricopharyngeal myotomy is the keystone in the surgical treatment and may be complete with inversion, diverticulectomy or diverticulopexy according with the physical and clinical characteristics of diverticulum and the patient. There were excellent results in more than 90 per cent of the operated patients, with a low morbidity and no mortality.