2008 Annual Meeting Abstracts

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Background: Zenker's diverticula (ZD) can be treated by transoral diverticulostomy or open surgery (upper esophageal sphincter myotomy and diverticulectomy or diverticulopexy). The aim of this study was to compare the effectiveness of minimally invasive (Group A) versus traditional open surgical approach (Group B) in the treatment of ZD.
Methods: Between 1993 and September 2007, 128 patients underwent transoral stapling (n = 51) or cricopharyngeal myotomy and diverticulectomy or diverticulopexy (n = 77). All patients were evaluated for symptoms with a detailed questionnaire. Manometry recorded upper esophageal sphincter (UES) pressure, relaxations and intrabolus pharyngeal pressure. The dimension of the pouch was based on the barium swallow. The choice of the treatment was based on the operative risk, the size of the diverticulum and the patients’ preference. Long-term follow-up data were available for 120/128 (94%) patients with a median follow-up of 40 months (IQR: 17-83).
Results: Mortality was nil. Three patients (5.8%) in the group A and 10 in the group B (13%) had postoperative complications (p=n.s.). Hospital stay were markedly reduced in patients after diverticulostomy (p<0.01). Postoperative manometry showed a UES pressure reduction, improved UES relaxation, and decreased intrabolus pressure in both groups (p<0.05). Four patients in the open surgical group (5.2%) complained of severe dysphagia after surgery (3 of them required endoscopic dilations). In the transoral diverticulostomy group, 11 patients (21.5%) required additional septal reduction (n=8) or a surgical myotomy (n=3) for the persistence of symptoms (p<0.01). All these 11 patients had a ZD smaller than 3 cm in dimension. After primary treatment and complementary treatment, 93.5% and 96% of patients, respectively for group A and group B, were symptom-free or significantly improved at long term follow-up.
Conclusion: Diverticulostomy is safe, quick, and effective for most patients with medium-sized ZD, but open surgery offers better long-term results as primary treatment and should be recommended for younger, healthy patients, especially with small diverticula. Small ZD may represent a formal contraindication to the transoral approach because too short a septum does not allow a complete division of the sphincter fibers.

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