Utility of transcervical management of
Zenker ’ s diverticulum
B JACKSON, Z AHMAD, R P MORTON
Department of Otolaryngology – Head and Neck Surgery, Counties Manukau Health, Manukau City, Auckland,
New Zealand, and the Department of Surgery, University of Auckland
Abstract
Objective: To evaluate our results in treating Zenker’s diverticulum via the transcervical approach, and to compare
our experiences with a recent systematic review of both open and endoscopic approaches to the pharyngeal pouch.
Method: An audit yielded 41 consecutive cases of Zenker’s diverticulum treated between 2003 and 2013.
Results: All 41 patients underwent transcervical cricopharyngeal myotomy; 29 sacs also required ‘inversion’. The
median and mean length of hospital stay was 1 night and 2.5 nights respectively. The recurrence rate was 2.4 per
cent and the complication rate was 9.8 per cent.
Conclusion: When compared to reported endoscopic techniques, transcervical cricopharyngeal myotomy (with
or without inversion) in our unit resulted in: shorter hospital stay, a comparable complication rate and fewer
recurrences.
Key words: Zenker Diverticulum; Length Of Stay; Recurrence; Pharyngeal Pouch Syndrome; Inversion;
Endoscopic Stapling
Introduction
The transcervical approach to Zenker’s diverticulum
for inversion and cricopharyngeal myotomy remains a
viable treatment option in today’s endoscopic-dominant
world. Zenker’s diverticulum is a condition that was
initially treated via a transcervical approach to the
pulsion sac. Advances in technology have brought
about changes in the approach to the pouch. Today, it
is most commonly treated endoscopically via a trans-
oral route. Indeed, by 2004, 83 per cent of otolaryngol-
ogists in the UK favoured the endoscopic route to the
sac.
1
However, the transcervical approach to the pha-
ryngeal pouch (i.e. sac excision, suspension or inver-
sion) still has proponents today.
2
The interesting
history of Zenker’s diverticulum and its treatment has
been collated and described by Simic et al. in detail.
3
A recent systematic review of the literature suggests
that the two approaches, transcervical and endoscopic,
provide comparable overall outcomes, albeit with a dif-
ference in the pattern of complications.
4
It should be
noted that the various transcervical approaches are
often reported en bloc, where excision accounts for
the vast majority (84 per cent) of open procedures.
4
However, of the various external approach options,
the inversion technique is under-represented in the lit-
erature, with only 76 patients from 4 studies, compared
with 1990 cases of sac excision.
4
Inverting the sac is our favoured approach for
Zenker’s diverticulum; it does not involve a breach in
the oesophageal mucosa (unlike transcervical excision,
endoscopic laser or endoscopic stapling). In our experi-
ence, this technique is effective, and it carries a low risk
of complications and recurrence. Because reports of
inversion in the literature comprise only small
numbers of cases, we decided to review and report
our own recent experience with this technique.
Materials and methods
Approval for this study was obtained from the Regional
Ethical Committee and the Institutional Clinical Board.
A retrospective audit was performed of patients who
underwent transcervical treatment for Zenker’s diver-
ticulum performed by two surgeons from 2003 to 2013.
Data on demographics, surgery, length of hospital
stay, recurrence and other complications were extracted
from the clinical records, and the results were compared
to those in the literature. Statistical analysis was per-
formed using IBM SPSS
®
Statistics software, version
19.0. Cross-tabulation analysis was performed on cat-
egorical variables and independent samples t-tests
were run on the continuous variables to determine
whether the groups (inversion vs cricopharyngeal
myotomy only) were significantly different.
Accepted for publication 24 September 2015 First published online 26 November 2015
The Journal of Laryngology & Otology (2016), 130 (Suppl. S1), S16–S19. MAIN ARTICLE
© JLO (1984) Limited, 2015
doi:10.1017/S0022215115003205
%%"$(((#!#!#%#$ %%"$!!#
!(! #! %%"$(((#!#!# ##) #'$ % ! "# % $&% %! % # !# %#$ ! &$ ' %