Surgery for Zenker’s Diverticulum

A Zenker's diverticulum is an uncommon condition where a pouch, or bulge, forms in the lower throat. It often results in difficulty swallowing (dysphagia) and may trigger the regurgitation of food. Unfortunately, medication does not help symptoms and surgery is often recommended to remove the obstruction and restore the normal pathway for food.

Zenker's Diverticulum Causes and Symptoms

Zenker's diverticulum forms in an area of the esophagus where there's some degree of muscle weakness. Just below this area of muscle weakness is cricopharyngeus muscle. This muscles circles around the throat. In individuals with a Zenker’s diverticulum, the cricopharyngeus muscle is overly tightened causing an outpouching of the throat just above it. Foods tend to pocket into the pouch and have difficulty passing through the muscle into the esophagus.

In addition to difficulty swallowing, symptoms of Zenker's diverticulum may include:

• Regurgitation of undigested food/medication from the pouch back into the mouth
• Bad breath (halitosis)due to food and saliva collecting in the pouch
• Hoarseness
• Chronic coughing
• Aspiration

Diagnosing Zenker's Diverticulum

Diagnosis of Zenker's diverticulum involves a review of a patient's throat and swallow evaluation tests, such as an X-ray examination combined with a barium swallow (barium esophagram). A fiberoptic endoscopic evaluation of swallowing may be done to view the esophagus to determine how the growth is affecting the movement of food. Such tests are performed to rule out other possible abnormalities of the esophagus that may also result in swallowing difficulties.

Minimally Invasive Surgery

With minimally invasive surgery for Zenker's diverticulum, the pouch and cricopharyngeus muscle are accessed through the mouth. A laser or stapler is used to cu the cricopharyngeus muscle, resolving the obstruction into the esophagus.

Open Surgery for Zenker's Diverticulum

Open surgery requires an incision in the throat to access the affected part of the esophagus. The pouch is removed and the cricopharyngeus is cut.

More common in men than women, Zenker's diverticulum often affects older adults. The bulge may form slowly over time and only become problematic when it becomes large enough to make it difficult to swallow. When surgery is necessary, complication rates are lower for minimally invasive techniques. The type of surgery performed to clear the esophagus will depend on the size of the pouch.