Evaluation of the Different Transcervical Approaches for Zenker Diverticulum

Objective. The aim of this study was to evaluate the results of open surgical techniques in the treatment of Zenker diverticulum. Study Design. Case series with chart review. Setting. Academic tertiary referral center. Subjects and Methods. Fifty-four patients with Zenker diverticulum were treated using a transcervical approach. Three with a Brombart I diverticulum underwent a simple myotomy of the cricopharyngeal muscle. Myotomy was combined with a diverticulum inversion in 14 patients and myotomy with diverticulectomy was performed in 37 patients. The surgical procedures were compared with regard to mean anesthesia time, duration of hospitalization, overall complication rate and rate of serious complications, recurrence rate, and follow-up results. Results. Hospitalization times were significantly shorter in the inversion group (P = .024). No statistically significant differences were observed between the transcervical modalities for any of the other variables investigated. Conclusions. Inversion is an effective modality and is by definition less traumatic than traditional diverticulectomy. Although the size of the diverticulum appeared to be a helpful criterion, careful intraoperative evaluation is the key element in deciding which transcervical procedure should be used. In the authors’ view, inversion always should be considered if the individual anatomy of the diverticulum sac (in terms of pharyngeal pouch size and intactness of the mucosa) allows it