Zenker s diverticulum is a rare condition in which a pouch forms at the junction of the pharynx and the esophagus. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. Flexible endoscopic and surgical management of zenkers. Can be used for larger diverticulum as well, alone or in combination with another technique such as the stapler. If the diverticulum is small, the preferred surgical technique is a minimally invasive approach in which the pouch is accessed through the mouth. Cricopharyngeal myotomy remains a key element of surgical treatment of zenker diverticulum zd. Transoral endoscopic excision 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. Zenkers diverticulum uci head and neck surgery uci. Our nursing team is highly skilled in helping with this novel procedure. 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. 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. There are a number of surgical interventions for zenkers diverticulum. Management of zenker and hypopharyngeal diverticula richard.
A comparative analysis article pdf available in otolaryngology head and neck surgery 1511 april 2014 with 512 reads how we. 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. Flexible endoscopic zenkers diverticulotomy with a novel bipolar. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. A condition that progressively worsens over time, esophageal diverticulum most often strikes adults over 60 years of age. Zenkers diverticulum has long been recognized as a major cause of. Zenker s diverticulum is an acquired saclike outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through killians dehiscence. A barium swallow fluoroscopy allows your doctor to see how you swallow in motion. 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. The surgical procedure of choice in patients with symptomatic zenkers.
Larger, symptomatic cases of zenkers diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. The following are the presented options for the medical condition. This surgical option typically takes about 15 to 30 minutes to complete. Zenkers diverticulum an overview sciencedirect topics. This book is distributed under the terms of the creative commons. In the endoscopic technique the pouch and constricted area are approached through the mouth. 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. This book will serve as an invaluable resource for surgeons and clinicians responsible for the evaluation and care of patients with zenker s diverticula zd and hypopharyngeal diverticula. The condition goes by several names, depending on the location of the pouch. Endoscopic stapling technique of esophagodiverticulostomy. Surgical statistics were published during 20012011, including a group of 11 patients 5 men, that underwent surgical treatment for zenker diverticulum.
Management of zenker and hypopharyngeal diverticula. Endoscopic versus surgical approach in the treatment of zenkers. The diagnosis was based on a clinical picture severe dysphagia, regurgitations, weight loss and investigations barium passage, upper endoscopy. Koch m, mantsopoulos k, velegrakis s, iro h, zenk j.
To compare the different modalities for treatment of zenkers diverticulum and the associated clinical outcomes. The most common form, zenker s diverticulum is found at the level of the lower neck and usually at the back of the throat. Distinguish the best imaging modality to diagnose zenker s diverticulum. 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.
A zenker diverticulum may be surgically treated with an endoscopic, surgical diverticulectomy, or diverticulopexy. Endoscopic stapling technique for the treatment of zenker. What are the benefits of minimally invasive surgery to treat esophageal diverticulum. Different surgical techniques have been indicated for the management of zenkers diverticulum zd, including diverticulectomy. There are other new surgical procedures being developed, but not enough data to provide adequate statistical numbers. Zenkers diverticulum free download as powerpoint presentation. Different surgical techniques have been indicated for the management of zenker s diverticulum zd, including diverticulectomy, diverticulopexy, and diverticular inversion, with or. This is known in the 70s as the first surgical intervention for zenkers diverticulum. Zenkers diverticulum is diagnosed using a test called a barium swallow.
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. Surgical resection of diverticulum was done in 58 34% patients, and endoscopic diverticuloesophagostomy in 103 61% patients. The mortonbartley system classifies the diverticulum based on size with stage i. Zenkers diverticulum zd is an outpouching of tissue through killians triangle thought to be. Radiographic findings and complications after surgical or. Zenkers diverticulum southern california, orange county. Zenker s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. 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. Traditional surgery involves an open neck incision. 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. Assess the clinical presentation of zenker s diverticulum. A barium swallow is a special xray that highlights the inside of your mouth, pharynx, and esophagus. 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.
Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenker s diverticulum. The article perioperative care of the patient with zenker s diverticulum, is the basis for this aorn journal independent study. Zenker s diverticulum is an outpouching of the pharyngoesophagus. In 1958, harrison added myotomy in the surgical protocol of zenker diverticulum 11,12. 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. 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. Article pdf available in otolaryngology head and neck surgery 1511 april 2014.
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. The surgical techniques and strategies have changed, some falling in and out of favor over time. It is the most common type of oesophageal diverticula with a reported prevalence ranging between 0. The surgeon then uses a surgical stapler or laser to cut the cricopharyngeus muscle. 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. Upmc thoracic surgeons perform both traditional and minimally invasive surgery for treating zenker s diverticulum. This is known medically as an endoscopic zenkers diverticulectomy. Perioperative care of the patient with zenkers diverticulum. The history of zenker diverticulum and its treatment. Zenker s diverticulectomy resection of zenker s diverticula. Zenkers diverticulum is a type of diverticulum that develops in the. 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.
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. These diverticula are uncommon and tend to occur in elderly people. The type of surgical treatment recommended depends on the size and location of diverticula, and include. Zenkers diverticulectomy harmonic scalpel case examples. Patients with a pharyngoesophageal zenker s diverticulum may. Management of zenker and hypopharyngeal diverticula, pp. Management of zenker s diverticulum and postlaryngectomy.
However, the overall health of people in the generally older population of patients with zenker diverticulum may not allow a significant surgical undertaking. Principles of surgical treatment of zenker diverticulum. Endotherapy of zenker s diverticulum using the needleknife technique. 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. 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. The goal of this activity is to evaluate the diagnosis and management of zenkers diverticulum. Upon completion of this activity, participants will be able to. This presentation was done at the mm meeting to discuss techniques and management of a zenker s diverticulum. 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. Postoperative instructions following arizona sinus. Zenkers diverticulum location, symptoms, treatment. Clinic surgeons complete this division by using a zenker s diverticuloscope and a minimally invasive stapling technique to treat zenker s diverticulum.
Surgical technique for use of the harmonic scalpel for zenker s diverticulum patients should be intubated and general anesthesia introduced. Food may accumulate in the pouch, causing it to fill and at times regurgitate up. This technique is a modification of the endoscopic approach first described by. Surgical treatment of zenkers diverticulum request pdf. 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.
Surgical technique for use of the harmonic scalpel for zenker s diverticulum. The work presents the data on treatment of 170 patients with zenker s diverticulum. Several classification systems for zenker s diverticulum have been proposed including the brombart and the morton bartley systems. The resection can be performed through an open or endoscopic approach. Endoscopic treatment of zenker diverticulum pharyngeal pouch. Zenkers diverticulum occurs when a pouch, also called a diverticulum, develops in the throat at the base of the neck.
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