ASSESSMENT OF MECHANICAL AND MANUAL SUTURE IN THE SURGICAL TREATMENT OF THE PHARYNGOESOPHAGEAL DIVERTICULUM.

José Luis Braga De Aquino,José Francisco Salles Chagas,Marcelo Manzano Said,Maria Beatriz Nogueira Pascoal,Fernanda Fruet,Luis Antonio Brandi-Filho,Douglas Alexandre Rizzanti Pereira

doi:10.1590/s0102-6720201500040005

Abstract

Background: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea is to accomplish this surgical procedure, comparing the manual and mechanical suture, in order to evaluate the real benefit of the mechanical technique. Aim: To evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture with regard to local and systemic complications. Method: Fifty-seven patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagogram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (group B). Results: In the postoperative period, one patient of group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, three patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from group A presented such complication. Lung infection was present in five patients, being two (8.3%) of group A and three (9.0%) on B, having good outcomes after specific treatment. In the late review, done with 43 patients (94.4%) of group A and 22 (88.0%) on B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion: The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual one, because it provided a lower index of local post-surgical complications.

Highlights

The dates are somewhat divergent among the published studies, the pharyngoesophageal diverticulum was first described by Abraham Ludlow in 176417
Assessment In the 30th postoperative day, six patients (10.5%) presented fistula caused by dehiscence of the pharyngeal suture translated by the output of digestive secretion by the cervical drain from the 3rd to 5th postoperative days
In the other 51 patients, 23 of group A and 28 of group B, in which there was no clinical evidence of dehiscence of the pharyngeal suture for the lack of output of digestive secretion by the cervical drain until the 5th postoperative day, the contrasted exam was done, and it did not demonstrate fistula in the pharynx

Summary

Introduction

The dates are somewhat divergent among the published studies, the pharyngoesophageal diverticulum was first described by Abraham Ludlow in 176417. Zenker’s diverticulum basically consists of a dilated saccular deformation, located in the lower posterior wall of the pharyngeal mucosa, above the upper esophageal sphincter over a region located between the obliquely striated muscular fibers of the lower constrictor muscle of the pharynx and the transverse fibers of the cricopharyngeal muscle, known as Killian’s triangle. This region is more predisposed to herniation of the mucosa due to the high intraluminal pressure over this vulnerable area, in which the muscular fibers are more scarce, exposing the hypopharyngeal mucosa[1,27]. There are few studies pointing at the exact occurrence of Zenker’s diverticulum in South American countries, including Brazil, but is known that it is not a common disease among the population[1,2,21]

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