Surgery for Zenker’s Diverticulum involves cutting the cricopharygues muscle. A Zenker’s diverticulum is a pouch located in the back of the throat that causes difficulty swallowing.
There are two common surgeries performed for treatment of Zenker’s Diverticulum. Both are performed under general anesthesia with the patient asleep.
The first step is an esophagoscopy (link) in which a hollow tube is inserted through the mouth and used to identify the pouch. The pouch is filled with cotton so that it is later easily identified. A rubber tube is then placed in the esophagus to also aid in identification and allow for normal sizing of the esophagus after surgery.
A small cut is made in the neck and the pouch and esophagus are identified. The pouch is removed the defect is stapled. The cricopharyngeus muscle, located at the neck of the pouch, is cut to prevent reformation.
Patients are often fed through a nasogastric tube the first few days after this surgery. This allows time for the throat to heal.
Risks of a traditional Zenker’s diverticulectomy may include damage to the recurrent laryngeal nerve (the nerve which controls the vocal fold) resulting in hoarseness, breathing difficulty or trouble swallowing. Another risk is that of a leak of food and saliva contents from the throat to the neck through the area of the resected pouch.
Endoscopic surgery for Zenker’s diverticulum is minimally invasive approach in which the pouch is treated entirely through the mouth without the need for a cut on the skin. With the patient asleep esophagoscopy is used to identify the pouch. The overactive muscle is noted and cut with a laser or a stapler.
In this surgery the pouch is not removed – instead the overactive cricopharyngeus muscle which is responsible for pouch formation is cut and the pouch over time connects to the remainder of the esophagus. As such food no longer gets stuck in the pouch.
Endoscopic cricopharyngeal myotomy is a minimally-invasive approach through the mouth. With the patient asleep a laryngoscope is placed through the mouth and positioned behind the voice box. The muscular cricopharygeal bulge is identified and a laser is used to cut this muscle. A stapler may also be used to cut the muscle as well.
Success rate for surgery is well over 90% with most patients able to swallow normally soon afterwards.
Zenker’s Diverticulum Surgery – This is a view through the mouth of the muscular bar running horizontally which separates the esophagus from the pouch. The diverticulum is located at the bottom of the image.
A stapler is inserted through the mouth into the esophagus. View after staple diverticulectomy show that the wall has been divided. Note the complete cut without any bleeding.
Patients may be asked to not eat for a small period of time after surgery to allow proper healing to occur. Typically there are less risks of fistula formation and nerve damage with the minimally invasive approach.