Introduction:Typically surgical correction of Zenker's diverticulum (ZD) is highly successful. However, some patients have recurrent symptoms following surgery. Studies focusing on the requirement for and results of reoperation for ZD are rare, largely due to the infrequent incidence of this disorder. The aim of this study was to review our experience with reoperation for ZD.
Method and material: A retrospective chart review of patients who underwent reoperation for ZD from 1998-2006. Reoperation consisted of Trans-Oral Endoscopic Stapling (TES) or Open Cricopharyngeal (CP) Myotomy with either suspension or excision of the ZD.
Results:There were 10 male and 3 female patients and the average age was 72 years. Eleven patients had one previous ZD repair and two patients had 2 previous operations. The previous surgery was a TES in 2 patients and an open repair in 11 patients. Only 6 of the 11 patients with an open repair had a CP myotomy, and in 5 other patients the myotomy was less than 2 cm in length. Following the initial operation 3 patients had resolution of symptoms for greater than 4 years, 4 patients had recurrent symptoms within 6 months, and 6 patients had no improvement with the operation. Recurrent symptoms were dysphagia in 12, regurgitation in 7 and aspiration or pneumonia in 8 patients. The median time interval since the prior surgery was 16 months.The revision was performed as a TES in 3 and an open procedure in 10 patients. Complications consisted of esophageal leakage and cutaneous fistula (1), hematoma (1), Horner's syndrome (1), and neuropraxia of recurrent laryngeal nerve (2). At a mean follow up of 8.7 months 6 patients were asymptomatic, 3 had some residual symptoms, and in 4 patients there was no significant improvement in the symptoms. Subsequently 3 of these 4 patients underwent another operation for ZD.
Conclusion:Reoperation for ZD is feasible although in this elderly patient group complications are common. The majority of patients experienced partial or complete symptomatic improvement.