| Management of pharyngoesophageal (Zenker's) diverticulum: which technique? | |
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MedLine Citation:
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PMID: 12440629 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Incomplete symptomatic relief of pharyngoesophageal (Zenker's) diverticulum after endoscopic stapling or laser division has been reported by some authors. The clinical relevance of cricomyotomy, although supported by experimental data, remains controversial. METHODS: Operative procedures consisted of transcervical resection (n = 34, group I), transcervical resection plus cricomyotomy (n = 12, group II), transcervical cricomyotomy (n = 8, group III), transcervical cricomyotomy plus diverticulopexy (n = 47, group IV), endoscopic stapling division (n = 31, group V), and endoscopic laser division (n = 55; group VI). RESULTS: The percentage of totally asymptomatic patients was significantly (p < 0.004) higher after open procedures (combined groups I to IV) than after endoscopic treatment (combined groups V and VI) regardless of the size of the pouch (< 3 cm, 85% versus 25%; > or = 3 cm, 86% versus 50%). The percentage of patients with no or occasional (ie, fewer than twice a week) symptoms was significantly (p < 0.001) higher after open procedures (98%) than after endoscopic treatment (57%) for less than 3-cm diverticula whereas it was not higher (p = 0.409) for 3-cm or greater pouches (open, 97%; endoscopic, 88%). Furthermore, this percentage was similar (p > 0.286) after endoscopic stapling division and after endoscopic laser division (< 3 cm, 50% versus 58%; > or = 3 cm, 96% versus 80%). It was also similar (p > 0.197) after resection alone (group I) and after open operations including myotomy (combined groups II to IV) (< 3 cm, 100% versus 98%; > or = 3 cm, 92% versus 100%). Unlike endoscopic stapling and division, laser division was complicated by mediastinitis (2 patients), and 1 patient was referred because of cervical esophageal disruption during laser division. Five of six postoperative fistulas after resection occurred in patients who did not have myotomy, and 4 patients were referred 12 to 49 years after resection without myotomy for true recurrence of the pouch. CONCLUSIONS: Open techniques afford better symptomatic relief than endoscopic techniques, especially in patients with small diverticula. Endoscopic stapling and division is safer than laser division. Although very effective at midterm, resection without myotomy predisposes to the development of postoperative fistula and to recurrence of the pouch after many years. |
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Authors:
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Christian A Gutschow; Marc Hamoir; Philippe Rombaux; Jean-Bernard Otte; Louis Goncette; Jean-Marie Collard |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 74 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2002 Nov |
Date Detail:
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Created Date: 2002-11-20 Completed Date: 2002-12-04 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1677-82; discussion 1682-3 Citation Subset: AIM; IM |
Affiliation:
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Unit of Upper G-I Surgery, Louvain Medical School, Brussels, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Esophagoscopy* Female Humans Laser Therapy* Male Middle Aged Outcome and Process Assessment (Health Care) Pharyngeal Muscles / surgery* Postoperative Complications / etiology, surgery Recurrence Reoperation Retrospective Studies Surgical Staplers* Zenker Diverticulum / surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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