Zenker s diverticulum is a pseudodiverticulum of the esophagus that forms in the killians triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. The article perioperative care of the patient with zenker s diverticulum, is the basis for this aorn journal independent study. Zenkers diverticulum an overview sciencedirect topics. Perioperative care of the patient with zenkers diverticulum. Killianjamieson diverticulum, cervical esophageal diverticulum, zenker s diverticulum, pharngoesophageal diverticulum, diverticulopexy introduction killianjamieson kj diverticulum was first described by ekberg and nylander in 1983 1. The work presents the data on treatment of 170 patients with zenker s diverticulum. Zenkers diverticulum location, symptoms, treatment. A barium swallow is a special xray that highlights the inside of your mouth, pharynx, and esophagus. Prep and drape the patient in the appropriate fashion with protection of the teethgums.
Comparing different surgical approaches for zenkers. Principles of surgical treatment of zenker diverticulum. Can be used for larger diverticulum as well, alone or in combination with another technique such as the stapler. The goal of this activity is to evaluate the diagnosis and management of zenkers diverticulum. Traditional surgery involves an open neck incision. Article pdf available in otolaryngology head and neck surgery 1511 april 2014. Endoscopic treatment of zenker diverticulum pharyngeal pouch. Zenkers diverticulum is diagnosed using a test called a barium swallow. Surgical treatment of zenkers diverticulum request pdf. Endoscopic versus surgical approach in the treatment of zenkers.
Surgical technique for use of the harmonic scalpel for zenker s diverticulum patients should be intubated and general anesthesia introduced. The resection can be performed through an open or endoscopic approach. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. This presentation was done at the mm meeting to discuss techniques and management of a zenker s diverticulum. However, the overall health of people in the generally older population of patients with zenker diverticulum may not allow a significant surgical undertaking. Zenker s diverticulum is an acquired saclike outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through killians dehiscence.
Patients with a pharyngoesophageal zenker s diverticulum may. Upon completion of this activity, participants will be able to. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. A zenker s diverticulum zd is a rare condition where an outpouching occurs where your throat meets your esophagus, the swallowing pipe that leads into your stomach. Surgical treatment has evolved, formerly requiring an external incision and resection of the diverticulum but more recently being accomplished using laryngoscopy or flexible endoscopy to cut the septum between the diverticulum and the esophageal lumen while transecting the cpm. Different surgical techniques have been indicated for the management of zenker s diverticulum zd, including diverticulectomy, diverticulopexy, and diverticular inversion, with or. Sometimes, other conditions are present alongside zenker s. Indications for zenker s diverticulectomy dysphagia difficulty swallowing partial obstruction aspiration of fluid causing coughing spells choking sensation pain on swallowing diagnosis of zenker s. Although there is a lack of randomized clinical trials, surgeons favor minimally invasive endoscopic techniques stapling or laser diverticulostomy because they are believed to cause fewer complications and produce similar outcomes to classic. Endoscopic stapling technique for the treatment of zenker. Larger, symptomatic cases of zenkers diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. The microendoscopic approach with the co 2 laser is a recommendable method for the treatment of zenker s diverticulum and pseudodiverticulum in the postlaryngectomy patient. Due to the distress experienced by patients from symptoms of the diverticulum, as well as the risk of aspiration and pneumonia, surgical intervention is recommended for all patients with zenkers diverticulum that are physically able to undergo surgery. Surgery either open or minimally invasive is the main therapeutic approach.
Zenkers diverticulectomy harmonic scalpel case examples. In 1917, mosher had introduced the technique that uses a rigid endoscope, with the section of the septum of the diverticulum, which was later improved by dohlman in 1960 and collard in 1993, as the performances of the endoscopes got better. Background presently, the 2 most widely used methods for the treatment of zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard openneck technique involving diverticulectomy and cricopharyngeal myotomy. This is known in the 70s as the first surgical intervention for zenkers diverticulum. The condition goes by several names, depending on the location of the pouch. Flexible endoscopic and surgical management of zenkers. Zenkers diverticulum is a type of diverticulum that develops in the. The surgical technique with the co 2 laser at low power settings is a less invasive, quick, relatively safe, and effective procedure requiring only short hospitalization. In 1958, harrison added myotomy in the surgical protocol of zenker diverticulum 11,12. These diverticula are uncommon and tend to occur in elderly people.
The surgeon then uses a surgical stapler or laser to cut the cricopharyngeus muscle. Management of zenker s diverticulum and postlaryngectomy. Surgical resection of diverticulum was done in 58 34% patients, and endoscopic diverticuloesophagostomy in 103 61% patients. Zenkers diverticulum occurs when a pouch, also called a diverticulum, develops in the throat at the base of the neck.
However, in recent times nonsurgical endoscopic techniques have gained more importance as they allow for much faster recovery, and the currently preferred treatment is endoscopic stapling 5 6 i. This surgical option typically takes about 15 to 30 minutes to complete. The most common form, zenker s diverticulum is found at the level of the lower neck and usually at the back of the throat. Postoperative instructions following arizona sinus. The history of zenker diverticulum and its treatment. Zenker s diverticulum is an outpouching of the pharyngoesophagus. Most often found in individuals over the age of 50 but possible at even younger ages, zenker s diverticulum is a disorder of the throat in which a diverticulum, a pouch, develops in the throat wall. Zenkers diverticulum uci head and neck surgery uci. Zenkers diverticulum zd is an outpouching of tissue through killians triangle thought to be. This is known medically as an endoscopic zenkers diverticulectomy. Zenker s diverticulum is a rare condition in which a pouch forms at the junction of the pharynx and the esophagus. Classical symptoms of zenkers diverticulum are progressive oropharyngeal dysphagia usually to solids and liquids, regurgitation often hours after ingestion of undigested food debris due to food entrapment in the diverticulum, pharyngeal stasis of secretion, chronic cough. Our skilled thoracic surgeons are experienced in performing a wide range of surgical options for the repair of zenker s diverticulum, allowing them to expertly determine the best course of treatment for your unique situation.
Different surgical techniques have been indicated for the management of zenkers diverticulum zd, including diverticulectomy. Distinguish the best imaging modality to diagnose zenker s diverticulum. Food may accumulate in the pouch, causing it to fill and at times regurgitate up. Zenker s diverticulectomy resection of zenker s diverticula. When this happens, a pouch forms and mucous, food, andor liquid can become stuck instead of going down your esophagus and into your stomach like normal. It is the most common type of oesophageal diverticula with a reported prevalence ranging between 0. Assess the clinical presentation of zenker s diverticulum. Such newer approaches include the transoral resection of diverticula tord which specifically addresses small zenker s diverticulum which esd is not good at addressing as well as flexible instead of rigid endoscopic approach. Surgery for pharyngeal pouch zenker s diverticulum daniel schuster, james netterville, johan fagan this chapter provides an overview of management of zenker s divertula zd, including detailed surgical technique, with an emphasis on effective therapy and management. Flexible endoscopic zenkers diverticulotomy with a novel bipolar. When this happens, a pouch forms and mucous, food, andor liquid can become stuck instead of going down your esophagus and into your stomach like. To compare the different modalities for treatment of zenkers diverticulum and the associated clinical outcomes. There are a number of surgical interventions for zenkers diverticulum.
Koch m, mantsopoulos k, velegrakis s, iro h, zenk j. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa. The diagnosis was based on a clinical picture severe dysphagia, regurgitations, weight loss and investigations barium passage, upper endoscopy. The behavioral objectives and examination for this program were prepared by helen starbuck pashley, rn, ma, cnor, consulting editor and susan madick, rn, cnor, with consultation from susan bakewell, rn, ms, professional education specialist, center for.
Radiographic findings and complications after surgical or. Endotherapy of zenker s diverticulum using the needleknife technique. Transoral endoscopic excision of zenker s diverticulum. A barium swallow fluoroscopy allows your doctor to see how you swallow in motion. Surgical statistics were published during 20012011, including a group of 11 patients 5 men, that underwent surgical treatment for zenker diverticulum. Several classification systems for zenker s diverticulum have been proposed including the brombart and the morton bartley systems. Surgical treatment of zenkers diverticulum fulltext digestive. Management of zenker and hypopharyngeal diverticula. The following are the presented options for the medical condition. The mortonbartley system classifies the diverticulum based on size with stage i. This book is distributed under the terms of the creative commons.
The surgical techniques and strategies have changed, some falling in and out of favor over time. Management of zenker and hypopharyngeal diverticula, pp. The type of surgical treatment recommended depends on the size and location of diverticula, and include. Endoscopic stapling technique of esophagodiverticulostomy.
A condition that progressively worsens over time, esophageal diverticulum most often strikes adults over 60 years of age. The etiology of zenker s diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. What are the benefits of minimally invasive surgery to treat esophageal diverticulum. Our nursing team is highly skilled in helping with this novel procedure. A zenker diverticulum may be surgically treated with an endoscopic, surgical diverticulectomy, or diverticulopexy. In the endoscopic technique the pouch and constricted area are approached through the mouth. Clinic surgeons complete this division by using a zenker s diverticuloscope and a minimally invasive stapling technique to treat zenker s diverticulum. A comparative analysis article pdf available in otolaryngology head and neck surgery 1511 april 2014 with 512 reads how we. Zenker s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. The minimally invasive technique uses a transoral throughthemouth approach. There are other new surgical procedures being developed, but not enough data to provide adequate statistical numbers. Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenker s diverticulum. Zenker s diverticulum zd is a saclike outpouching of the mucosa and submucosa through killians triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle.
This technique is a modification of the endoscopic approach first described by. Cricopharyngeal myotomy remains a key element of surgical treatment of zenker diverticulum zd. Zenkers diverticulum has long been recognized as a major cause of. The surgical procedure of choice in patients with symptomatic zenkers. Surgical technique for use of the harmonic scalpel for zenker s diverticulum.