Upper Gastrointestinal Surgery Unit

PHARYNGO-ESOPHAGEAL (ZENKER'S) DIVERTICULUM

Pharyngo-esophageal (Zenker's) diverticulum is a pouch that develops from the posterior pharyngeal wall secondary to a lack of compliance of a small muscle (i.e cricopharyngeus muscle) located within the upper segment of the esophagus.

The mainstay of treatment is the division of the cricopharyngeus muscle (cricomyotomy) so that hypopharyngeal intraluminal pressure normalizes and the pharyngo-esophageal junction opens on deglutition.

The choice of the most relevant procedure depends on the size of the diverticulum:

  • Very small diverticulum (1 cm) requires division of the cricopharyngeus muscle only, the diverticular mucosa realigns itself with the esophageal mucosa after cricomyotomy. This operation is carried out through a small incision in the left side of the neck. Most patients are able to ingest food and are discharged home the day after the operation.
  • Medium-size diverticulum (1-3 cm) is best treated by division of the cricopharyngeus muscle and anchorage of the diverticular pouch on to the posterior wall of the pharynx (myotomy-pexy) . This operation is carried out through a small incision in the left side of the neck. Most patients are able to ingest food and are discharged home the day after the operation.
  • Large diverticulum (> 3 cm) may be treated by either myotomy-pexy or endoscopic stapling division of the common wall between the diverticulum and the esophagus according to an original procedure designed and validated in the Unit (1991). Most patients are able to ingest food and are discharged home the day after the operation.