What are the steps in Zenker's diverticulum (ZD) surgery?

From the Guidelines

Zenker's diverticulum surgery should be performed using an endoscopic approach, specifically endoscopic staple diverticulotomy, to divide the cricopharyngeal muscle and eliminate the pouch, as it is the most effective and commonly used procedure today. The steps in Zenker's diverticulum surgery typically involve:

• General anesthesia to ensure patient comfort and safety
• Placement of a specialized diverticuloscope to expose the common wall between the esophagus and diverticulum
• Use of an endoscopic stapler to cut and seal the septum, creating a common cavity and relieving the obstruction
• Alternative techniques, such as endoscopic laser or harmonic scalpel division, may be used in some cases
• Postoperatively, patients typically start with clear liquids and advance to a soft diet over several days The decision to perform Zenker's diverticulum surgery is supported by the UK guidelines on oesophageal dilatation in clinical practice, which recommend considering upper oesophageal sphincter dilatation in the treatment of dysphagia with disordered upper oesophageal sphincter opening, including cases with a Zenker’s diverticulum 1. Some key points to consider when performing Zenker's diverticulum surgery include:
• The importance of addressing the underlying dysfunctional cricopharyngeal muscle that causes food to collect in the pouch
• The potential complications of the procedure, including perforation, bleeding, dental injury, or recurrence
• The high success rates of the procedure, with 90-95% of patients experiencing symptom relief
• The need for careful patient selection and preoperative evaluation to determine the best approach for each individual case.

From the Research

Steps in Zenker's Diverticulum Surgery

The steps in Zenker's diverticulum (ZD) surgery can vary depending on the approach used. The main goal of the surgery is to relieve symptoms such as dysphagia and regurgitation. Here are the general steps involved in ZD surgery:

• Preoperative assessment: The patient's condition and the size of the diverticulum are evaluated to determine the best approach for surgery 2.
• Anesthesia: The patient is given general anesthesia to ensure comfort during the procedure.
• Surgical approaches: There are several surgical approaches to treat ZD, including:
  • External excision (diverticulectomy) with or without myotomy 3.
  • Diverticulopexy, an endoscopic approach 3.
  • Cricopharyngeal myotomy alone 3.
  • Endoscopic stapled diverticulotomy 2.
  • Laser endoscopic surgery 4.
• Resection of the diverticulum: The diverticulum is resected using a stapler device or manually 5.
• Myotomy: The cricopharyngeal muscle is cut to relieve spasms and improve swallowing 2.
• Closure: The incision is closed, and the patient is taken to the recovery room.

Surgical Techniques

Different surgical techniques can be used to treat ZD, including:

• Open surgery: This involves making an incision in the neck to access the diverticulum 5.
• Endoscopic surgery: This involves using a flexible or rigid endoscope to visualize the diverticulum and perform the surgery 2, 4.
• Laser surgery: This involves using a laser to cut the cricopharyngeal muscle and resect the diverticulum 4.

Postoperative Care

After the surgery, the patient is monitored for complications and given pain medication as needed. The patient is also given instructions on how to care for the wound and what to expect during the recovery period. The average hospital stay is around 5-9 days, and the patient can usually resume oral intake within 4-5 days 5, 4.