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J Thorac Cardiovasc Surg 2003;125:969-971
© 2003 The American Association for Thoracic Surgery

Brief Communications

Minor challenges: Modified diverticulectomy and myotomy for recurrent Zenker diverticulum

From the General Thoracic Surgical Unit, Massachusetts General Hospital, Boston, Mass.

Received for publication Aug 12, 2002. Accepted for publication Aug 22, 2002. Address for reprints: Douglas J. Mathisen, MD, Massachusetts General Hospital, 55 Fruit St, Blake 1570, Boston, MA 02114 (E-mail: dmathisen@partners.org).

The first 20% of the full text of this article appears below.

Pharyngoesophageal diverticulum or Zenker diverticulum is a relatively uncommon surgical problem. The cause of this entity has been debated but still remains inconclusive. The symptoms of dysphagia, regurgitation of undigested food, aspiration, noisy deglutition, halitosis, and voice changes usually prompt surgical correction. ¹ A variety of techniques have been proposed for its correction, including diverticulopexy, diverticulectomy, cricopharyngeal myotomy, and endoscopic stapling or lasering. All of these techniques have proponents and detractors. ^1-5

The most common technique to treat Zenker diverticulum has been combined diverticulectomy and cricopharyngeal myotomy. This approach has achieved excellent results, with an overall success rate of 95%, a recurrence rate of 3.6%, and a low mortality rate of 1.2%. ⁵ This has been our standard approach, with equally good results. We have usually performed the diverticulectomy open over a 40F to 50F bougie. The resulting defect is closed with inverting 4-0 silk sutures. The adjacent esophageal muscle is closed over the repair for the second layer of closure. Subsequently, a myotomy is then performed at a remote site on the esophagus.

During a recent operation for a failed repair performed elsewhere, there was little available esophageal muscle for the second layer of closure after resecting the diverticulum and completing the myotomy. We chose to use the omohyoid muscle to buttress the diverticulectomy site and to separate the edges of the myotomy, with excellent results.

Failed operations for Zenker diverticulum pose challenging problems. Tissue planes are difficult to identify because of . . . [Full Text of this Article]