Rapid Communication
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2007; 13(18): 2586-2589
Published online May 14, 2007. doi: 10.3748/wjg.v13.i18.2586
Long-term results of endosurgical and open surgical approach for Zenker diverticulum
Luigi Bonavina, Davide Bona, Medhanie Abraham, Greta Saino, Emmanuele Abate
Luigi Bonavina, Davide Bona, Medhanie Abraham, Greta Saino, Emmanuele Abate, University of Milano, Department of Medical and Surgical Sciences, Section of General Surgery, I.R.C.C.S Policlinico San Donato, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Luigi Bonavina, U.O. Chirurgia Generale, I.R.C.C.S. Policlinico San Donato Via Morandi 30, 20137 San Donato Milanese (Milano),Italy. luigi.bonavina@unimi.it
Telephone: +39-2-52774621 Fax: +39-2-52774622
Received: January 15, 2007
Revised: January 18, 2007
Accepted: January 31, 2007
Published online: May 14, 2007
Abstract

AIM: To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum.

METHODS: Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years.

RESULTS: The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3 cm).

CONCLUSION: Both operations relieve the outflow obstruction at the pharyngoesophageal junction, indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach. Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter.

Keywords: Esophagus; Zenker diverticulum; Cricopharyngeal myotomy; Diverticulectomy; Dysphagia; Aspiration pneumonia