title: Long-Term Outcome of the Treatment of Zenker's Diverticulum.
abstract: BACKGROUND
  Treatment of Zenker's diverticulum can be accomplished by use of a transcervical myotomy (TCM) with diverticulopexy/diverticulectomy or by the transoral endoscopic stapling (TOS) approach. Our aim was to evaluate the short-term and long-term outcomes of these two techniques.
  
  
  METHODS
  A retrospective review was performed to identify all patients who had received either treatment for Zenker's diverticulum from July 1998 to August 2013. Telephone interviews were attempted of all surviving patients to assess long-term outcome.
  
  
  RESULTS
  There were 77 patients, with a median age of 71 years (range, 37 to 97 years). All patients had dysphagia, and 33 (43%) had regurgitation. TCM was performed in 68 patients, and TOS was done in nine. The median size of the diverticulum was 2.5 cm in the TCM group and 4 cm in the TOS group (p = 0.13). The operation was primary in 66 patients (86%) and a reoperation in 11 patients. The median hospital stay was 1 day for TOS and 3 for TCM (p = 0.0005). The median time to oral intake for both groups was 1 day. There were three adverse events in the TCM group and none in the TOS group. Early outcome was assessed in all 77 patients at a median of 4 months (interquartile range [IQR], 1 to 13.5 months). Symptomatic improvement occurred in all patients, with 55 patients (71%) reporting complete resolution. Long-term symptoms were assessed at a median of 54 months (IQR, 34 to 77 months) in 38 of 59 (64%) surviving patients.
  
  
  CONCLUSIONS
  Cricopharyngeal myotomy with diverticulopexy/diverticulectomy and TOS are both safe and effective treatments for Zenker's diverticulum. All patients reported improvement in symptoms, with complete resolution in the majority of patients.
authors.affiliation: Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Greene
authors.affiliation: Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: P Michael
authors.initials: PM
authors.lastname: McFadden
authors.affiliation: Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Oh
authors.affiliation: Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Chang
authors.affiliation: Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California. Electronic address: jeffrey.hagen@med.usc.edu.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hagen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D012189:Retrospective Studies; D017792:Surgical Stapling; D013997:Time Factors; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*