Surgical Treatment For Zenkerís Diverticulum: A Critical Evaluation Of The Outcomes
*Haley Leesely, *Roberto Cortez, *Michael Kwok, *Lindsey Moran, Thomas Ng
Brown Medical School, Providence, RI
Objective:There exist several treatment options for Zenkerís cervical esophageal diverticulum; in this study we aim to evaluate the modern-day outcomes of surgical therapy.
Design:Retrospective cohort study from prospective database with median follow-up of 617 days.
Setting:Tertiary care academic center.
Patients:Consecutive patients undergoing surgical therapy for Zenkerís diverticulum.
Interventions: Left cervical incision and cricopharyngeal myotomy, with or without diverticulectomy.
Main Outcome Measures:Rate of complete resolution of dysphagia (score of 0) after surgery, postoperative complication rates and postoperative rate of the side effect of water brash.
Results:From 2003 to 2019, 57 consecutive patients were evaluated. Median age was 71 years, 41(72%) were male, median age-adjusted co-morbidity index was 4. Presentation included dysphagia in 57(100%), regurgitation 40(70%), choking 36(63%), weight loss 11(19%), pneumonia 8(14%), halitosis 6(11%) and feeding tube in 4(7%). Work-up included barium swallow in 57(100%); 22(38%) underwent upper endoscopy prior to barium swallow with diverticulum not visualized in 5/22(23%). Median diverticulum size was 4.0cm. Regarding the surgical procedure, 54(95%) underwent stapled diverticulectomy and myotomy, 3(5%) underwent myotomy only, median blood loss was 25cc, and median length of stay was 2 days. There was no operative mortality. Morbidity was seen in 5(9%), one patient each of staple line leak, bleeding requiring re-operation, and wound hematoma, and two patients with wound infection. After median follow-up of 617 days, 54(95%) reported no dysphagia of any degree (score of 0), and 2(3.5%) reported new water brash.
Conclusions: Surgical treatment for Zenkerís diverticulum can be performed with low complication rates, and results in a high rate of complete resolution of dysphagia which is durable. This modern surgical series can be used to compare the results of other therapies, namely endoscopic approaches.
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