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Zenker’s Diverticulum

Zenker’s Diverticulum is the development of a pouch (diverticulum) in the wall of the lower throat. It usually occurs in people over age 50. The pouch slowly fills with food with every swallow.

Once the pouch is filled, it may spill into the throat, causing coughing and spitting up of food swallowed many hours earlier. The filled pouch may also press on the upper esophagus, making it difficult for food to pass.

The exact cause of developing a Zenker’s Diverticulum is not known. It is thought that weakness in the muscle of the throat, dysfunction of the cricopharyngeal muscle (upper esophageal sphincter) and poor swallowing coordination lead its development. For this reason, it is uniformly accepted that division of the Cricopharyngeal muscle is necessary for successful surgical treatment of Zenker’s Diverticulum.

There are three surgical methods of treating Zenker’s Diverticulum. The endoscopic surgical option is used the majority of the time. The open neck approaches are only utilized when the endoscopic technique is not possible.

Endoscopic Zenker’s Diverticulum Surgery:

In this surgery, the wall separating the pouch and the esophagus is divided endoscopically. Surgery is done under general anesthesia, via a laryngoscope, an instrument inserted through the mouth to view the wall separating the esophagus and the diverticulum. Using a laser or a stapling device, the common wall between the pouch and esophagus, which includes the cricopharyngeal muscle, is divided. This approach eliminates the pouch by making it part of the upper esophagus.

Recovery after an endoscopic excision of Zenker’s Diverticulum is fast and easy. Patients often go home the same day or the day following surgery. They can drink liquids after the surgery and are usually able to return to a normal and solid diet in approximately a week.

Diverticulectomy:

Diverticulectomy involves an operation requiring an incision on the neck in order to access the diverticulum. Open neck techniques are used only when the endoscopic approach is not possible. In this technique, the pouch is identified and removed. In addition, the cricopharyngeal muscle is divided.

Patients are often observed in the hospital for three to four days and start a liquid diet three days after surgery. They are usually able to return to a normal and solid diet in approximately a week.

Diverticulopexy:

Diverticulopexy involves an operation requiring an incision on the neck in order to access the diverticulum. Open neck techniques are used only when the endoscopic approach is not possible. The pouch is isolated and tacked upside-down so that the mouth of the pouch is in a dependent position. In addition, the cricopharyngeal muscle is divided. Diverticulopexy is less invasive than Diverticulectomy.

Patients often go home in a few days. They can drink liquids after the surgery and are usually able to return to a normal and solid diet in approximately a week.