Long-term results of endosurgical and open surgical approach for Zenker diverticulum.
OBJECTIVE
To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum.


METHODS
Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years.


RESULTS
The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3 cm).


CONCLUSIONS
Both operations relieve the outflow obstruction at the pharyngoesophageal junction, indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach. Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter.
Bonavina
Luigi
L
University of Milano, Department of Medical and Surgical Sciences, Section of General Surgery, IRCCS Policlinico, San Donato, Italy. luigi.bonavina@unimi.it
Bona
Davide
D
Abraham
Medhanie
M
Saino
Greta
G
Abate
Emmanuele
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*