[Plea in favour of external cervicotomy approach of Zenker's diverticulum: 73 cases reported].

INTRODUCTION

Zenker's diverticulum can be treated surgically or endoscopically. The aim of this study was to assess results of surgical approach with cervicotomy and diverticulectomy.

PATIENTS AND

METHODS

We retrospectively studied the data of 73 patients (50 men and 23 women; mean age, 69 ans; extrêmes: 43-98) consecutively operated on for a Zenker's diverticulum between 1987 and 2000. Surgical procedure included diverticulectomy associated with a large myotomy and oesophageal calibration. Both early and long-term results were compared with those of published series of patients treated by stapled esophagodiverticulostomy.

RESULTS

Clinical manifestations were: dysphagia (97%), regurgitations (76%), aspirations (45%), weight loss (28%), lung infection (21%), or halitosis (3%). No patient died postoperatively. The early morbidity rate was 4% (3 patients). The mean delay for return of oral feeding and the mean length of hospital stay were respectively 6 and 8 days. At follow-up (mean follow-up, 6 years; extremes: 3 months-13 years), 72 patients (99%) were satisfied and 1 patient felt partially improved. Analysis of published results of series of endoscopic treatment revealed shorter lengths of hospital stay but less favourable long-term results.

CONCLUSIONS

Early morbidity of surgical treatment of Zenker's diverticulum is low. Long term functional results could be better after surgical diverticulectomy with myotomy than after endoscopic stapled esophagodiverticulostomy.