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OPEN SURGICAL APPROACH FOR RECURRENT ZENKER's DIVERTICULUM AFTER ENDOSCOPIC REPAIR
Takuya Ogami*, Vic Velanovich
Surgery, University of South Florida, Tampa, FL
Background: The definitive treatment of Zenker's diverticulum (ZD) is mainly a repair by either endoscopic repair or open surgical approach. Endoscopic repair seems to be safe and feasible, however, the recurrence rate was reported as 18.4% comparing to 4.2% for open approach in a recent systematic review. The management of recurrent ZD is not well established. We herein report the outcome of open approach for recurrent ZD after endoscopic repair.
Method: A retrospective review of electrical medical records was performed in our tertiary university-affiliated institution from 2010 to 2015. Data of patients who failed endoscopic repair previously and underwent open approach were obtained. The data included demographic information, outcomes including symptomatic relief, follow up duration, and complications.
Results: Fifty patients underwent surgical procedures including endoscopic repair and open repair. Three patients presented with recurrent ZD after endoscopic repair and open repair was chosen (See Table). All procedures were performed with combination of diverticulectomy and cricopharyngeal myotomy. All patients experienced symptomatic relief which existed preoperatively. The follow up duration was ranged from 13 days to 7 months. No recurrence was found. One patient developed vocal cord paralysis which was managed conservatively.
Conclusion: We experienced 3 patients who developed recurrent ZD after endoscopic approach treated with open repair with successful symptom relief. Open surgical approach can be considered as an optimal option after failure of endoscopic treatment.
| Patient | Age | Time from previous procedure | Preoperative symptoms | Follow up | Complication | | 1 | 80 | 16 months | Dysphagia, regurgitation | 13 days | None | | 2 | 83 | 36 months | Choking, weight loss | 1 month | Vocal cord paralysis | | 3 | 81 | 24 months | Dysphagia, weight loss | 7 months | None |
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