Revista do Colégio Brasileiro de Cirurgiões
Print version ISSN 0100-6991
ANDREOLLO, Nelson Adami et al. Surgical treatment of the zenker's diverticulum. Rev. Col. Bras. Cir. [online]. 1998, vol.25, n.1, pp.9-14. ISSN 0100-6991. http://dx.doi.org/10.1590/S0100-69911998000100004.
The Zenker’s diverticulum is a not frequent disease and the main symptom is the cervical dysfagia. The aspects of the pathophysiology had motivated many researchs in the literature, using manometric and cinerradiographic studies. The surgical treatment is most commonly employed, favouring the most number of patients, with low recurrence rates. However, some publications show the advantages of the endoscopic treatment. Thirty nine patients with Zenkers diverticulum were operated on in the last 15 years, being 28 males (71.8%), with the age ranging from 18 to 86 years (mean 54.5 years). The main symptoms were: cervical dysphagia (89.8%), food regurgitation (71.8%), cough (30.7%) and losting weight (25.6%). Two patients presented diverticulitis and perforated diverticulum (5.1%). The diagnosis were established using esophagogram in 37 patients (94.8%) and digestive endoscopy in 28 (71.7%). The manometric studies were performed in 13 cases (33.3%). The treatment consisted of diverticulectomy followed by the cricopharyngeal sphyncter myotomy in 24 patients (61.5%) or diverticulopexy also followed by the same myotomy in 15 patients (38.5%). The late follow-up of 35 patients (89.8%) ranging from five months to 12 years (mean 4.5 years) showed that all oft hem were without symptoms of dysphagia. Three patients (7. 7%) presented light and inconstant dysphagia. One patient died due to pulmonary and cardiac problems (2.5%). The histopathology studies of the diverticulum showed a malignant tumor in one case (2.5%). The patients submitted to diverticulopexy were discharged early. The authors discuss the modern aspects of the physiopathology of the Zenker’s diverticulum, they analyse the choices of treatment and the results of literature, comparing to the obtained in the present study. Concluding, the results of this study showed that either the diverticulectomy as the diverticulopexy are indicated, both followed by cricopharyngeal sphincter myotomy. The diverticulopexy is a very good choice to treat small and middle diverticulum.
Keywords : Zenker's diverticulum; Diverticulectomy; Diverticulopexy.