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EXPLORING THE INFLUENCE OF DIVERTICULAR NECK SIZE ON CLINICAL MANIFESTATIONS AND SURGICAL OUTCOMES IN ZENKER'S DIVERTICULUM: A RETROSPECTIVE COHORT ANALYSIS
Rockey Dahiya
*, Natalie Weiss, Phllip Pirgousis
Department of Surgery, Mayo Foundation for Medical Education and Research, Rochester, MN
Zenker’s diverticulum (ZD) is a mucosa and submucosal outpouching that develops through a muscular defect in Killian’s triangle, located between the inferior constrictor and cricopharyngeal muscle. Structurally, ZD comprise of two components: the neck and the pouch. As the diverticular pouch enlarges and retains contents, patients may present with symptoms such as halitosis, regurgitation, gurgling, or cough. Surgical intervention remains the treatment of choice, tailored to the size of the pouch and the severity of symptoms. However, despite the paramount role of diverticulum neck in the passage of contents, there is a notable lack of literature evaluating the relationship between diverticular neck size and preoperative symptoms and surgical outcomes.
A retrospective chart review of patients who underwent surgery for ZD between 2014-2024 was performed. Information was collected regarding baseline characteristics (age, sex, BMI, race, comorbidities, ZD pouch size (<1,1-3,>3 cm), symptoms, past medical history of cardiovascular, respiratory, hyperlipidemia, hypertension, renal disease), operative information (surgical approach, length of stay, and initiation of liquid, soft, and regular diet), and post-operative outcomes (recurrence till recent follow-up) was collected. Cohort was divided into two groups based on diverticular neck size (<10.5mm vs. ?10.5mm) and cut off was established based on previous literature. Descriptive analysis was done utilizing Fisher’s exact test (categorical variables) or a Wilcoxon rank sum test (continuous and ordinal variables).
A total of 55 patients were included in the study, of whom 62.14% were males. The cohort had a mean age of 71.5 years, an average BMI of 27.45 kg/m2, and a mean diverticular neck size of 9.6 ±7.23mm. Notably, 63.4% of patients had a diverticular neck size of less than 10.5mm (group1). On comparison (group1 vs group2), diverticular size was less than 1cm in 5.7% vs 0%, between1&3cm in 62.8% vs 40% (p=0.08), and greater than 3 cm in 28.57% vs 55% (p=0.05) of patients. Dysphagia was reported in 80% vs 65% (p=0.1), cough in 2.86% vs 20% (p=0.05), and regurgitation in 28.57% vs 50% (p=0.09). A statistically significant correlation was observed between diverticular neck size and diverticular size greater than 3cm (p=0.05). However, no significant association was found between diverticular neck size and recurrence of ZD.
This study suggests that, while diverticulum neck size may influence symptom such as cough and pouch size, it does not appear to have a significant impact on the recurrence of ZD following surgical intervention.
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