In the literature, various theories concerning the cause of Zenker's diverticulum have been propounded. I believe that an anatomic predisposition plays a prominent role in the pathogenesis. This conclusion will be discussed in light of a study of the literature and characteristics of a series of 646 patients with Zenker's diverticulum. The current methods of treatment by an external surgical approach, as well as the (micro)endoscopic procedures, are described.

Pathogenesis and Methods of Treatment of Zenker's Diverticulum:

https://www.giejournal.org/article/S0016-5107(99)70452-9/pdf

Endoscopic treatment of Zenker's diverticulum☆☆☆

Background:

The development of endoscopic techniques, particularly endoscopic stapling, has led to a re-evaluation of the treatment of pharyngeal pouch. The pathophysiology and treatment of the condition is reviewed.



Methods:

An electronic literature search was undertaken on the pathophysiology, history and surgery of pharyngeal pouch (Zenker's diverticulum). These last two terms were used to the search the Cochrane, Medline and Embase databases (from 1966 to date) and the bibliographies of extracted articles.



Results and conclusion:

With recognition of the central role of the cricopharyngeus muscle in the pathogenesis of pouch formation, the emphasis on treatment has shifted from diverticulectomy to cricopharyngeal myotomy. Minimally invasive techniques have become established since the advent of endoscopic stapling devices. Although randomized controlled data are lacking, the endoscopic approach appears to offer advantages in terms of a shorter duration of anaesthesia, more rapid resumption of oral intake, shorter hospital stay and quicker recovery. It is associated with excellent success rates and minimal morbidity. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Evolution of surgical treatment for pharyngeal pouch

Objectives The objectives of the present study are to review the technique of endoscopic staple-assisted esophagodiverticulostomy (ESED) for the treatment of Zenker's diverticulum and to describe our e-perience and modifications with ESED and the advantages of ESED over previous treatments of Zenker's diverticulum.



Study Design Retrospective review of 74 cases of ESED performed for the treatment of Zenker's diverticulum.



Methods Patient's records were retrospectively reviewed and tabulated for age, se-, size of diverticulum, symptoms, duration of symptoms, operative time, length of postoperative hospital stay, oral intake, complications, and relief of symptoms.



Results The senior author (r.l.s.) previously reported results in 36 cases of ESED performed in 34 patients with Zenker's diverticulum. We have performed an additional 38 cases of ESED in 37 patients between March 1997 and August 1999. The rate of success of ESED was similar between the two series. The average perioperative time, time until oral intake, and length of postoperative hospital stay decreased in the second series. Overall, there were no mortalities and few complications with ESED. Compared with other forms of treatment of Zenker's diverticulum, such as Dohlman's procedure, diverticulectomy, and diverticulopexy, ESED has a similar rate of success, decreased perioperative time, decreased convalescence, and decreased mortality and complications.



Conclusions Cost-effectiveness, safety, and efficacy of ESED offer new advantages over previously used treatments for Zenker's diverticulum. These results continue to support the use of ESED as the initial treatment of choice for patients with Zenker's diverticulum.

Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for Zenker's diverticulum.

Pharyngeal pouch surgery by the external approach has been shown to be effective but has a relatively high complication rate. We compared the outcome of 17 patients who had cricopharyngeal myotomy alone or combined with excision/inversion/suspension, simple pouch excision and Dohlman's procedure with 17 patients who had the relatively new Endo GIA-30 endoscopic stapling technique. Results were obtained retrospectively by postal questionnaire and medical records. We conclude that endoscopic stapling shortens the return to normal diet and in-patient stay. These patients also experience better swallowing and are generally more satisfied with the procedure. We have accepted endoscopic stapling as the method of choice for the treatment of pharyngeal pouches.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0022215100143658

Comparison of the endoscopic stapling technique with more established procedures for pharyngeal pouches: results and patient satisfaction survey.

Twenty years' experience with the surgical treatment of Zenker's diverticulum is discussed, with emphasis on 25 patients treated by the Dohlman endoscopic method since 1959. In these patients, mostly elderly, the sac was not removed, but the wall between the esophagus and pouch was divided endoscopically. There were no deaths and no instances of mediastinitis or hemorrhage. Twenty-four of the 25 patients were able to eat with much greater ease. The chief advantages of the endoscopic approach are its extreme brevity of two to five minutes, lack of morbidity, and lack of threat to the recurrent laryngeal nerve. Reoperations are as simple as the original.

Trible Wm

Papers

The surgical treatment of Zenker's diverticulum: endoscopic vs external operation.