Tailored approach to Zenker's diverticula.
BACKGROUND
Zenker's diverticula (ZD) can be treated by diverticulostomy or open surgery (upper esophageal sphincter myotomy and diverticulectomy or diverticulopexy). The aim of this study was to compare the outcome of the two alternative treatments.


METHODS
Fifty eight patients were scored for symptoms and upper esophageal sphincter (UES) pressure; relaxations and intrabolus pressures were recorded by manometry. Treatment depended on operative risk and ZD size. Twenty four patients with high surgical risk and/or a <3-cm or >5-cm pouch underwent diverticulostomy; the other 34 had open surgery.


RESULTS
Mortality was nil. Five patients had postoperative complications after open surgery (p<0.05). Hospital stay was shorter after diverticulostomy (p<0.001). Follow-up (41 months; range, 1-101) was obtained in 53 patients. Postoperative manometry showed a UES pressure reduction, improved UES relaxation, and lower intrabolus pressure in both groups (p<0.05). In the diverticulostomy group, three patients complained of severe dysphagia. vs none in the open surgery group (p<0.05).


CONCLUSIONS
Diverticulostomy is safe, quick, and effective for most patients with medium-sized ZD, but open surgery offers better long-term results and should be recommended for younger, healthy patients with small or very large diverticula.
Zaninotto
G
G
Department of Medical and Surgical Sciences, Clinica Chirurgica 4, University of Padova School of Medicine, Via Giustiniani 2, 35128 Padova, Italy. giovanni.zaninotto@unipd.it
Narne
S
S
Costantini
M
M
Molena
D
D
Cutrone
C
C
Portale
G
G
Costantino
M
M
Rizzetto
C
C
Basili
U
U
Ancona
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D017792:Surgical Stapling; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000503:physiopathology / Q000601:surgery*