Skip to main content

Advertisement

SpringerLink
Log in

Endoscopically stapled diverticulostomy for Zenker’s diverticulum: results of a multidisciplinary team approach

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

A variety of open and endoscopic surgical approaches for the treatment of Zenker’s diverticulum have been described. In recent years, growing evidence has shown that the endoscopic techniques are superior to the open approaches in many aspects. Among the endoscopic techniques, endoscopically stapled diverticulostomy (ESD) appears to have better efficacy and safety than the other endoscopic techniques.

Methods

This study retrospectively reviewed the medical records of all the patients with Zenker’s diverticulum treated surgically by the same team, which involved an ear, nose, and throat surgeon and an endoscopic surgeon.

Results

From January 2002 to March 2008, 55 consecutive patients with Zenker’s diverticulum underwent 60 ESDs. The mean follow-up time was 32.6 months (range, 1–72 months). The mean operative time was 21.8 min (range, 5–45 min), and the average hospital stay was 2.24 days (range, 1–30 days). The treatment was technically feasible for 51 patients (93%), and initial symptom relief without recurrence was achieved for 46 patients (90.2%) after a single procedure. Five patients with recurrent symptoms underwent a successful revision ESD, with a 100% success rate among the patients for whom the procedure was technically feasible. Only two major postoperative complications (3.64%) occurred: one esophageal perforation and pneumomediastinum and one severe esophageal edema. Both patients had complete resolution of their complications with conservative treatment and no long-term sequela.

Conclusion

The findings showed endoscopic stapled diverticulostomy to be both safe and effective. Compared with the historical results of open diverticulectomy and myotomy, the reported procedure has fewer complications and better outcomes and should become the procedure of choice for the treatment of most patients with a diagnosis of Zenker’s diverticulum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ludlow A (1769) A case of obstructed deglutition from a preternatural dilatation of and bag formed in the pharynx. Med Obs Inq 3:85–101

    Google Scholar 

  2. Zenker FA, von Ziemssen H (1878) Dilatations of the esophagus. Cyclopedia Pract Med 3:46–48

    Google Scholar 

  3. Mosher HP (1917) Webs and pouches of the esophagus: their diagnosis and treatment. Surg Gynecol Obstet 25:175–187

    Google Scholar 

  4. Dohlman G, Mattson O (1960) The endoscopic operation for hypopharyngeal diverticula. Arch Otolaryngol Head Neck Surg 71:744–752

    CAS  Google Scholar 

  5. Knegt PP, de Jong PC, van der Schans EJ (1985) Endoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser. Endoscopy 17:205–206

    Article  PubMed  CAS  Google Scholar 

  6. Kuhn FA, Bent JP (1992) Zenker’s diverticulotomy using the Ktp/532 laser. Laryngoscope 102:946–950

    Article  PubMed  CAS  Google Scholar 

  7. Von Doersten PG, Byl FM (1997) Endoscopic Zenker’s diverticulotomy (Dohlman procedure): forty cases reviewed. Otolaryngol Head Neck Surg 116:209–212

    Article  Google Scholar 

  8. Collard JM, Otte JB, Kestens PJ (1993) Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thorac Surg 56:573–576

    Article  PubMed  CAS  Google Scholar 

  9. Scher RL, Richtsmeier WJ (1998) Long-term experience with endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope 108:200–205

    Article  PubMed  CAS  Google Scholar 

  10. Narne S, Cutrone C, Bonavina L, Chella B, Peracchia A (1999) Endoscopic diverticulotomy for the treatment of Zenker’s diverticulum: results in 102 patients with staple-assisted endoscopy. Ann Otol Rhinol Laryngol 108:810–815

    PubMed  CAS  Google Scholar 

  11. Baldwin DL, Toma AG (1998) Endoscopic stapled diverticulotomy: a real advance in the treatment of hypopharyngeal diverticulum. Clin Otolaryngol Allied Sci 23:244–247

    Article  PubMed  CAS  Google Scholar 

  12. Koay CB, Bates GJ (1996) Endoscopic stapling diverticulotomy for pharyngeal pouch. Clin Otolaryngol Allied Sci 21:371–376

    Article  PubMed  CAS  Google Scholar 

  13. Omote K, Feussner H, Stein HJ, Ungeheuer A, Siewert JR (1999) Endoscopic stapling diverticulostomy for Zenker’s diverticulum. Surg Endosc 13:535–538

    Article  PubMed  CAS  Google Scholar 

  14. Smith SR, Genden EM, Urken ML (2002) Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique: a direct comparison and charge analysis. Arch Otolaryngol Head Neck Surg 128:141–144

    PubMed  Google Scholar 

  15. Chang CY, Payyapilli RJ, Scher RL (2003) Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope 113:957–965

    Article  PubMed  Google Scholar 

  16. Miller FR, Bartley J, Otto RA (2006) The endoscopic management of Zenker diverticulum: CO2 laser versus endoscopic stapling. Laryngoscope 116:1608–1611

    Article  PubMed  Google Scholar 

  17. Peracchia A, Bonavina L, Narne S, Segalin A, Antoniazzi L, Marotta G (1998) Minimally invasive surgery for Zenker’s diverticulum: analysis of results in 95 consecutive patients. Arch Surg 133:695–700

    Article  PubMed  CAS  Google Scholar 

  18. Schmit PJ, Zuckerbraun L (1992) Treatment of Zenker’s diverticulum by cricopharyngeus myotomy under local anesthesia. Am Surg 58:710–716

    PubMed  CAS  Google Scholar 

  19. Laccourreye O, Menard M, Cauchois R et al (1994) Esophageal diverticulum: diverticulopexy versus diverticulectomy. Laryngoscope 104:889–892

    PubMed  CAS  Google Scholar 

  20. Scher RL (2003) Endoscopic staple diverticulostomy for recurrent Zenker’s diverticulum. Laryngoscope 113:63–67

    Article  PubMed  Google Scholar 

  21. Thaler ER, Weber RS, Goldberg AN, Weinstein GS (2001) Feasibility and outcome of endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope 111:1506–1508

    Article  PubMed  CAS  Google Scholar 

  22. Aggerholm K, Illum P (1990) Surgical treatment of Zenker’s diverticulum. J Laryngol Otol 104:312–314

    Article  PubMed  CAS  Google Scholar 

  23. Barthlen W, Feussner H, Hannig CH, Holscher AH, Siewert JR (1990) Surgical therapy of Zenker’s diverticulum: low risk and high efficiency. Dysphagia 5:13–19

    Article  PubMed  CAS  Google Scholar 

  24. Cerdan FO, Gonzalez EM, Garcia DH (1998) Diagnostic and treatment of Zenker’s diverticulum: review of our series pharyngo-esophageal diverticula. Hepatogastroenterology 45:447–450

    Google Scholar 

  25. Payne WS (1992) The treatment of pharyngoesophageal diverticulum: the simple and complex. Hepatogastroenterology 39:109–114

    PubMed  CAS  Google Scholar 

  26. Lindgren S, Ekberg O (1990) Cricopharyngeal myotomy in the treatment of dysphagia. Clin Otolaryngol 15:221–227

    Article  PubMed  CAS  Google Scholar 

  27. Louie H, Zuckerbraun L (1993) Staged Zenker’s diverticulectomy with cervical esophagostomy and secondary esophagostomy closure for treatment of massive diverticulum in severely debilitated patients. Am Surg 59:842–845

    PubMed  CAS  Google Scholar 

  28. Dorion D, Brown D, Gullane P (1994) Zenker’s stapler diverticulectomy. J Otolaryngol 23:145–147

    PubMed  CAS  Google Scholar 

  29. Laing MR, Murthy P, Cockburn SW (1995) Surgery for pharyngeal pouch: audit of management with short- and long-term follow up. J R Coll Surg Edinb 40:315–318

    PubMed  CAS  Google Scholar 

  30. Ishioka S, Sakai P, Maluf Filho F, Melo JM (1995) Endoscopic incision of Zenker’s diverticula. Endoscopy 27:433–437

    Article  PubMed  CAS  Google Scholar 

  31. Mulder CJ, den Hartog G, Robijn RJ, Thies JE (1995) Flexible endoscopic treatment of Zenker’s diverticulum: a new approach. Endoscopy 27:438–442

    Article  PubMed  CAS  Google Scholar 

  32. Van Eeden S, Lloyd RV, Tranter RM (1999) Comparison of the endoscopic stapling technique with more established procedures for pharyngeal pouches: results and patient satisfaction survey. J Laryngol Otol 113:237–240

    PubMed  Google Scholar 

  33. Zbaren P, Schar P, Tschopp L, Becker M, Hausler R (1999) Surgical treatment of Zenker’s diverticulum: transcutaneous diverticulectomy versus microendoscopic myotomy of the cricopharyngeal muscle with CO2 laser. Otolaryngol Head Neck Surg 121:482–487

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology and Head and Neck Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel

    Oshri Wasserzug, Danny Zikk, Oren Cavel & Daniel Fleece

  2. Department of Surgery, Assia Medical Group, Tel Aviv, Israel

    Asnat Raziel

  3. Department of Surgery B, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 64239, Israel

    Amir Szold

Authors
  1. Oshri Wasserzug
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Danny Zikk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asnat Raziel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oren Cavel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Fleece
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amir Szold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amir Szold.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wasserzug, O., Zikk, D., Raziel, A. et al. Endoscopically stapled diverticulostomy for Zenker’s diverticulum: results of a multidisciplinary team approach. Surg Endosc 24, 637–641 (2010). https://doi.org/10.1007/s00464-009-0651-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0651-8

Keywords

Search

Navigation