Zenker Diverticulum: Cricopharyngeal Myotomy with Diverticulopexy versus Diverticulectomy.
Abstracts
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Introduction: Controversy still exists in the treatment of Zenker diverticula if the diverticulum should be resected (diverticulectomy) or fixed to the prevertebral fascia (diverticulopexy). The aim of this study was to compare the outcome of these two surgical options. Patients and methods: The study group consisted of 140 patients operated on Zenker diverticulum between 1984 and 1997. Morbidity and symptomatic outcome (standardized questionnaire) between the two groups were assessed. Results: Out of a total of 140 operated patients with Zenker diverticulum follow-up was available in 116 cases with a median follow-up of 70.8 months (range: 19-171). Thirty-five patients underwent myotomy with diverticulopexy and 81 patients myotomy with diverticulectomy. The majority of patients in whom a diverticulectomy was performed did have a big diverticulum (Brombart III or IV) in contrast to patients with diverticulopexy with an almost equal Brombart stage distribution. Morbidity included only surgically related complications such as fistula, wound infection, and bleeding. More than 90% of the patients in both groups were satisfied with the operative result. Conclusion: Based on these findings diverticulectomy should be reserved for big Zenker diverticula since it carries a high risk of postoperative complications. Treatment of choice for diverticula Brombart stage I-II should be myotomy with diverticulopexy. |
