Diverticuloplexy and Diverticulectomy for Zenker’s Diverticulum

A number of surgical options are available for treating Zenker’s diverticula (ZD). While small diverticula (smaller than 2 cm) may require no surgical treatment, the presence of dysphagia, aspiration, or other significant symptoms may necessitate surgery. Surgical options include both traditional open procedures as well as endoscopic and minimally invasive ones.

Cricopharyngeal (CP) myotomy -- the surgeon cuts the cricopharyngeal muscle and renders it useless. Because the muscle remains relaxed, it allows food to pass through while swallowing. This procedure can benefit patients who have to be fed through Percutaneous Endoscopic Gastrostomy (PEG) tubes to avoid choking on food. Small ZD are often treated with CP myotomy.

Diverticulectomy – the ZD is surgically excised. For patients with problematic symptoms, diverticulectomy is performed after CP myotomy. Diverticulectomy with CP myotomy is the standard treatment of ZD in the US, and is performed on intermediate to large diverticula (2 – 6 cm or larger).

Diverticulum invagination or imbrication– the diverticulum is pushed into the hypopharynx and sewn over. A CP myotomy usually follows.

Diverticuloplexy – the ZD is repositioned higher in the neck and sewn to the sternocleidomastoid muscle. A CP myotomy usually follows. This is performed for very large diverticula.

Endoscopic Surgery for Zenker’s Diverticulum

While traditional surgery for ZD requires an external approach, many ZD patients are elderly and can not undergo open surgical procedures. Minimally invasive endoscopic techniques have been developed using operating laryngoscopes, laparoscopic instruments and staplers. These developments now allow some patients to undergo surgery endoscopically, on an outpatient basis, and resume oral diet quickly after the operation (usually the following day). Stapling has become the preferred endoscopic approach by physicians as it is safe, effective, and causes few complications.

Laser surgery using CO2 microsurgery can also be a successful method of excision for many patients. The laser may be used instead of traditional incisions.