Surgical Treatment of Zenker’s Diverticulum In Older Patients

Abstract

Zenker’s diverticulum is a cause of benign dysphagia. The main symptoms include dysphagia and regurgitation and require diagnostics to exclude neoplastic disease. Surgical treatment is recommended for symptomatic patients. The methods of treatment include endoscopic and open transcervical techniques. Thirty-eight patients treated using the open technique between 2000 and 2020 were analyzed. Patients were qualified for the procedure after a complete diagnosis that excluded the neoplastic process. All patients were assessed for the degree of dysphagia, weight loss, and comfort after surgery. All patients underwent a transcervical diverticulum resection with a myotomy of the cricopharyngeal muscle for a minimum length of 3 cm. After surgery, the patients showed improvement in swallowing and could be fed orally; their diet was complete. One patient (2.6%) had an esophageal fistula which was successfully treated conservatively, two patients (5.2%) required reoperation due to postoperative bleeding, and two patients (5.2%) experienced temporary laryngeal nerve palsy. One patient required retreatment due to recurrent diverticula 20 months after the surgery. There was no death in the perioperative period. ‘Very good’ long-term functional results were obtained in 27 (71.1%) patients, ‘good’ in eight (21.1%), and ‘bad’ in three (7.9%). The traditional open technique of treating cervical diverticula of the esophagus is safe for older patients, has an acceptable percentage of postoperative comorbidity, and yields good functional results.