[Transoral video-endoscopic esophageal diverticulostomy--a new treatment method for Zenker's diverticulum].
70% of the esophageal diverticula are pharyngoesophageal diverticula. They are caused by a malfunction of the superior esophageal sphincter. Surgical treatment consisted of a myotomy of the superior esophageal sphincter and the resection of the diverticulum through a lateral cervical incision. With the described new endoscopic transoral technique the septum between the diverticulum and the esophagus is divided by a stapling device and both lumina are combined resulting in a esophago-diverticulostomy. At the same time a myotomy of the transverse part of cricopharyngeal muscle and the proximal esophageal wall is performed. Due to the design of the stapling device usually a small pouch remains at the bottom of the diverticulum. A modification of the stapler instrument allowed us to shorten the length of this pouch. The time of the endoscopic procedure is markedly reduced compared to the conventional surgical intervention. There is no necessity for special postoperative wound care and the hospital stay is considerably shortened. Furthermore serious complications like fistulas and lesions of the recurrent nerve, encountered with the open surgical intervention, are avoided. This new technique combines the advantages of a minimal invasive approach and the development of new instruments with the confided principles of the conventional operation in treating the pathogenetical mechanisms of Zenker's diverticulum. To assess the value of the technique long term follow up studies as well as comparative trials will be needed.
Clerici
T
T
Klinik für Chirurgie Kantonsspital St. Gallen.
Nägeli
J
J
Lange
J
J
D019723:Endoscopes; D020701:Esophagoscopes; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D013528:Surgical Staplers; D013536:Suture Techniques / Q000295:instrumentation; D014741:Video Recording / Q000295:instrumentation*; D016672:Zenker Diverticulum / Q000601:surgery*