Combined endoscopic treatment for Zenker's diverticulum versus open approach; review of our experience

Abstract Introduction Zenker's diverticulum is a superior esophagus sphincter disease appropriate for surgical management in symptomatic cases. This treatment has undergone important changes in recent years. Material and methods A retrospective review was carried out on 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used, as well as a combined endoscopic approach with stapler and CO 2 laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay, and occurrence of relapses were analyzed. Results The endoscopic approach was used in 8 patients, converting to conventional open surgery being necessary in 2 cases. Operating time was 90 min for the open approach and 45 for the endoscopic. Oral feeding could be reintroduced 36 h after open surgery and 24 h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery; one case was treated with the endoscopic approach and the other with the open approach. Conclusions The combined endoscopic approach offers good results in patients with symptomatic Zenker's diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when good endoscopic exposure is not possible.