Zenker's diverticulum surgical technique book

Surgical statistics were published during 20012011, including a group of 11 patients 5 men, that underwent surgical treatment for zenker diverticulum. Zenker s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. Zenker s diverticulum zd is a posterior pharyngoesophageal pouch that forms through pulsion forces in an area of relative hypopharyngeal wall weakness between the oblique fibers of the inferior pharyngeal constrictor and the horizontal fibers of the cricopharyngeus cp muscles. An indepth look at the esophagus and its conditionsthis book investigates the anatomy, physiology, and pathology of the esophagus. The diagnosis was based on a clinical picture severe dysphagia, regurgitations, weight loss and investigations barium passage, upper endoscopy. Operative dictations in general and vascular surgery, second edition is intended to teach residents the principles of succinct and precise operative dictations for a wide spectrum of surgical procedures. Edited by eugene myers, charles bluestone, derald brackman, charles krause. Zenker s diverticulum zd, also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and. Zenkers diverticulum clinical gastroenterology and hepatology.

Apr 3, 2017 the main cause of zenkers diverticulum is thought to be malfunctioning of the cricopharyngeal muscle due to the aging process. Zenkers diverticulum uci head and neck surgery uci ent. This happens when there is pressure on your pharynx and it balloons out. Andrew michael courson md ent doctor near you houston. The mainstay of treatment was previously open surgical correction and endoscopic management with rigid endoscope, but advances in flexible endoscopic tools and techniques have brought flexible endoscopic management to the forefront over the past two decades. Endoscopic pharyngoesophageal diverticulostomy is performed to address an abnormal pouch diverticulum that originates above a constriction at the entrance to the esophagus. The surgical approach involves an external neck incision with cp myotomy diverticulotomy, with or without pouch intervention inversion.

Why would a zenkers diverticulum recur after surgical. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. Sometimes, other conditions are present alongside zenker s. Minimally invasive approach revolutionizes lung cancer surgery. The management of the diverticular sac after myotomy is still a matter of debate. Advance your surgical expertise with atlas of advanced operative surgery.

This endoscopic technique consists of a transoral surgical procedure that divides the septum party wall between the zd and the cervical. Upon completion of this activity, participants will be able to. The more common etiologies of dysphagia that lend themselves to surgical correction are described. Feb 22, 2012 in 1917, mosher had introduced the technique that uses a rigid endoscope, with the section of the septum of the diverticulum, which was later improved by dohlman in 1960 and collard in 1993, as the performances of the endoscopes got better. Comparing different surgical approaches for zenkers diverticulum. Management of zenker and hypopharyngeal diverticula. There are a number of surgical interventions for zenkers diverticulum. Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal disorder with an annual incidence of just 2 per 100,000.

Zenkers diverticulum repair what is zenkers diverticulum. Fibreoptic diverticular repair is another of the methods for treating ze. Cricopharyngeal myotomy remains a key element of surgical treatment of zenker diverticulum zd. Designed as a portable resource, the book provides typical dictations to guide the resident. Reliable information about the coronavirus covid19 is available from the world health organization current situation, international travel. Background the 2 most frequently used endoscopic methods to treat zenkers diverticulum are stapleassisted and co2 laser esophagodiverticulostomy. Zenkers diverticulum zd results from posterior herniation of esophageal mucosa into killians triangle, an area of least resistance situated above the cricopharyngeus cp muscle and below the inferior pharyngeal constrictor muscle. The advent of endoscopic techniques has transformed the surgical therapy of zenkers diverticula. Atlas of advanced operative surgery 1st edition pdf free. Outcomes favoring the stapler technique included a shorter duration of nil per os npo status 2 studies, length of. Distinguish the best imaging modality to diagnose zenkers diverticulum. Given our findings, we recommend considering diverticulopexy rather than diverticulectomy in a patient with a zenker s diverticulum greater than 10 cm 2 in size if a cervical approach is the selected treatment. More than 50% of the affected patients present in 6080 years of life. The endoscopic stapling technique has revolutionized the treatment of zd.

Zenkers diverticulum location, symptoms, treatment, diet. Surgery for pharyngeal pouch zenkers diverticulum english, cricopharyngeal myotomy surgical technique. This raphe suspends the pharynx from the base of skull at the pharyngeal tubercle, which is a palpable bump. Essential operative techniques and anatomy, 4eand its accompanying online component. The most effective surgical treatment for this condition is a procedure that serves to relieve pressure in the esophagus and improve swallowing by cutting the muscular sphincter at the top of the esophagus. Head and neck surgery, 3volume set, edition 5 ebook written by paul w. Some neurologic diseases, such as a stroke, may result in malfunctioning of the cricopharyngeal muscle. Apr 04, 2014 surgical techniques for zenkers diverticulum.

Zenkers diverticulum an overview sciencedirect topics. Thieme ejournals endoscopy international open full text. Central ohio technical college hocking college surgical technology program welcome surgical technology students you are embarking on an exciting and challenging field of study. Zenker s diverticulum is diagnosed using a test called a barium swallow. The etiology of zenker s diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenkers diverticulum. The trauma of the pharyngeal posterior wall occurs intraoperatively and can pass unnoticed. Open zenkers diverticulectomy using stapling techniques. The surgeon then uses a surgical stapler or laser to cut the cricopharyngeus muscle.

In 1958, harrison added myotomy in the surgical protocol of zenker diverticulum 11,12. Operative dictations in general and vascular surgery. Classical symptoms of zenkers diverticulum are progressive oropharyngeal dysphagia usually to solids and liquids, regurgitation often hours after ingestion of undigested food debris due to food entrapment in the diverticulum, pharyngeal stasis of secretion, chronic cough. Todd baron defines zenker s diverticulum and its symptoms. Conclusions diverticulotomy of the esophagealdiverticular septum with ligasure is an outpatient endoscopic technique that is simple, effective in the long term and very safe for the treatment of patients with zenkers diverticulum. All 3 constrictors pass around and insert into a midline raphe on the posterior pharynx and vary in where they originate. The diverticulum can frequently be the etiology for aspiration and pneumonia and should therefore be repaired in patients capable of tolerating the operative procedure. Cummings otolaryngology head and neck surgery e book. This surgery is performed by dr kanaan in mission viejo and irvine.

He has written numerous publications as well as a book. Jameson l chassin this surgical atlas should be of great value to all clinical surgeons, both those in training and those in surgical practice, and dr. Orientation of the parts thereby becomes more challenging. Patients with this condition often exhibit no symptoms. Background presently, the 2 most widely used methods for the treatment of zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard openneck technique involving diverticulectomy and cricopharyngeal myotomy. Endoscopic stapling technique for the treatment of zenker. It is the most common type of oesophageal diverticula with a reported prevalence ranging between 0. A tailored approach to the surgical treatment of zenkers diverticula. Surgical exposure in endoscopic repair of zenkers diverticulum tends to be significantly less successful in patients with short necks, decreased hyomental distance, andor a high bmi. The bottom of the throat is surrounded by a muscle called the cricopharyngeus.

The use of opencell foam and elastic foam tape as an effective and convenient skin simulator for teaching suturing technique. Minimally invasive thoracic surgery mission viejo vat. A zenkers diverticulum, more formally known as a hypopharyngeal diverticulum, is a pouch that can form at the junction of the hypopharynx lower part of the throat and the esophagus, an area known as killians triangle. Scottconner, 97814614929, available at book depository with free delivery worldwide. Surgical treatment of zenkers diverticulum springerlink. Surgical options include a variety of tools and techniques and to accomplish some combination of diverticulectomy. Zenkers diverticulectomy southern california, orange. Diverticulum treatment surgical techniques illustrated.

A rigid esophageal endoscopy is performed just before the operation. Because of the delicate architecture of the vocal folds, highlyskilled surgery is required to restore vibration to the vocal fold. This is known in the 70s as the first surgical intervention for zenkers diverticulum. Endoscopic versus surgical approach in the treatment of zenkers. Due to the distress experienced by patients from symptoms of the diverticulum, as well as the risk of aspiration and pneumonia, surgical intervention is recommended for all patients with zenkers diverticulum that are physically able to undergo surgery. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa. Koch m, mantsopoulos k, velegrakis s, iro h, zenk j. The sixth edition of the esophagus also explores the diagnosis and treatment of various esophageal conditions. Assess the clinical presentation of zenkers diverticulum.

A zenker s diverticulum is a pouch located in the back of the throat that causes difficulty swallowing. In summary, if the zenker s diverticulum is causing aspiration, i would recommend surgical treatment. A zenkers diverticulectomy three procedures have been described to treat a zenkers diverticulum. Zenkers diverticulum is a type of diverticulum that develops in the. Postoperative instructions following arizona sinus. General surgery clerkship curriculum declare the past, diagnose the present, and foretell the future. Endoscopic stapling is the currently preferred treatment for zenkers diverticulum, i. Therapy of symptomatic zd has evolved from an open surgical approach to less invasive transoral endoscopic techniques. Surgical experience of the national institution in the.

It\u2019s time to grab a copy of master techniques in surgery. A simple technique to improve external surgical treatment of zenkers diverticulum is presented. Dec 01, 2012 zenker s diverticulum is an acquired saclike outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through killian s dehiscence. Several classification systems for zenkers diverticulum have been proposed including the brombart and the morton bartley systems. The following are the presented options for the medical condition. A zenker s diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle i.

Chassins operative strategy in general surgery 4th edition pdf. The unit carries out diagnosis and treatment of benign diseases of the esophagus and gastroesophageal junction. Start studying surgical first assist practice exam. Atlas of advanced operative surgery 9781416041092 us. Endoscopic management of zenkers diverticulum practical. It is a pouch that forms in your pharynx, an area just above your esophagus or swallowing tube. Purchase atlas of head and neck surgery 1st edition. Different surgical techniques have been indicated for the management of zenkers diverticulum zd, including diverticulectomy. Minimally invasive thoracic surgery or mits can be performed using video assistance or robotic assistance.

This book is distributed under the terms of the creative commons. Malfunctioning of the cricopharyngeal muscle with aging seems to be the main cause. Surgery may be indicated for some vocal fold lesions. By the time these patients reach the surgeon, the diverticula have attained sufficient dimensions to warrant surgical excision in practically every instance. Successful completion of our course of studies meets the qualifying standards required to take the national certification examination for surgical technologies. Videoassisted thoracic surgery or vats is a surgical technique that involves insertion of a thorascope. It is a pseudo diverticulum not involving all layers of the esophageal wall. Chassins operative strategy in general surgery 4th.

A comparative analysis article pdf available in otolaryngology head and neck surgery 1511 april 2014 with 512 reads how we measure reads. Endoscopic treatment, although frequently performed, has not replaced the open cricopharyngeal myotomy, which is still deemed the standard therapy by many dedicated physicians. A zenkers diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle i. Oclcs webjunction has pulled together information and resources to assist library staff as they consider how to handle. The fourth edition of chassins operative strategy in general surgery. Zenkers diverticulum uci head and neck surgery uci.

Since the surgical view is a line of sight only through a narrow opening, the technique requires cutting through the tumor in pieces to accomplish removal. Baron also discusses traditional surgical management, as well as endoscopic treatment of zenker s diverticulum. That is why a diverticulectomy alone is not performed, because the underlying problem will not be addressed. Surgery for zenker s diverticulum involves cutting the cricopharygues muscle. If the diverticulum is small, the preferred surgical technique is a minimally invasive approach in which the pouch is accessed through the mouth. There is a common wall that separates the esophagus from the diverticulum pouch. Zenkers diverticulectomy open approach iowa head and. Why would a zenker s diverticulum recur after surgical treatment. If you are wanting to access the uploaded articles linked below then you must be logged into portal. This pulsion diverticulum is composed of mucosa, covered by thin areolar tissue, herniating at killians triangle between the obliquely positioned inferior constrictor muscle and the transversely oriented cricopharyngeus muscle. Chang has treated patients with zenkers diverticulum, a rare throat pouch, from throughout the united states using only the minimally invasive, rigid endoscopic technique known as endoscopic staple diverticulostomy or esd.

Click here to jump down to questions about treatment. Posted on mar 25, 2014 in surgical techniques illustrated 4 comments. May 25, 2017 your doctor may consider surgical options depending on the location and if you have a more severe case. Learn vocabulary, terms, and more with flashcards, games, and other study tools. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas key features. As a consequence of this, the learning curve for this technique. Principles of surgical treatment of zenker diverticulum. Cummings otolaryngology head and neck surgery ebook. Clayman, delivers unparalleled visual guidance and insight to help you master the most important and cuttingedge head and neck procedures.

Zenkers diverticulum zd is an outpouching of tissue through killians triangle thought to be. Extraesophageal reflux in patients suffering from zenker s diverticulum. Flexible endoscopic zenkers diverticulotomy with a novel bipolar. Atlas of minimally invasive surgical techniques, by drs. Both are performed under general anesthesia with the patient asleep. Despite recurring reports in the literature during the past decade which depict a rather bleak outlook for surgical therapy, the problem of malignancy of the esophagus remains a most important one in the overall consideration of diseases of the. Advances in otolaryngologyhead and neck surgery, vol i. Concise yet complete, this easily accessible text captures groundbreaking techniques such as videoassisted thyroid and parathyroid surgeries. A barium swallow is a special xray that highlights the inside of your mouth, pharynx, and esophagus. There are two common surgeries performed for treatment of zenker s diverticulum. Combination of surgical and endoscopic approach for zenkers. When food and saliva fill up the pouch, however, symptoms can occur and may include. Cricopharyngeal myotomy an overview sciencedirect topics. Zenker diverticulum, also known as a pharyngeal pouch, is a posterior outpouching of the hypopharynx, just proximal to the upper esophageal sphincter through a weakness in the muscle layer called the killian dehiscence.

Atlas of advanced operative surgery 1st edition pdf. Dec 14, 2016 surgical treatment of zenkers diverticulum. A single lumen tracheal tube is inserted into the esophageal lumen to serve as a stent. Atlas of minimally invasive surgical techniques ebook. Endotherapy of zenkers diverticulum using the needleknife technique. The goal of this article is to illustrate our tailored approach to patients with.

The ideal surgical technique for symptomatic zenkers diverticulum has not been identified yet. A further advantage is the decreased morbidity associated with this technique. Because the condition is very rare, you should find a doctor who is experienced in either the. Gastroesophageal reflux and hiatal hernia paraesophageal and diaphragmatic hernia achalasia zenkers diverticulum and other esophageal diverticula patients with benign esophageal diseases can be visited and undergo all relevant instrumental exams. Diverticular resection, as well as a concomitant cricopharyngeal myotomy. Review of literature and experience in 159 consecutive cases. Zenkers diverticulumminimally invasive treatment by. The surgical procedure of choice in patients with symptomatic zenkers. The indication for surgical treatment was based on the severe dysphagia, which may cause in more than half of the patients, important weight loss.

Pharyngoesophageal zenkers diverticulum is a false diverticulum of the cervical esophagus. Surgical treatment of zenkers diverticulum fulltext digestive. A barium swallow fluoroscopy allows your doctor to see how you swallow in motion. Visualize every procedure thanks to more than 1,000. Endoscopic treatment of zenkers diverticulum by carbon dioxide laser. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas.

Little is a thoracic surgeon in oro valley, arizona. Zenkers diverticulum southern california, orange county. Flexible endoscopic and surgical management of zenkers. Endoscopic pharyngoesophageal zenkers diverticulostomy. Zenker s diverticulum zd is a saclike outpouching of the mucosa and submucosa through killian s triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle. The diagnosis of zenkers diverticulum is normally confirmed following a visual inspection of the affected area using an endoscope or a swallowing study known as a modified barium swallow study or esophagram. Fully illustrated and comprising the clearest, most procedural approaches to esophageal surgery in any textbook available today, this surgical atlas distills vast stores of knowledge from the field\u2019s most renowned surgeons into one definitive book.

The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. It was followed by an otolaryngeal intraluminal technique with the dissection of the bridge that separates the diverticulum from the esophageal lumen. Numerous and frequentlyupdated resource results are available from this search. Expanded to 4 chapters and enhanced by new color photos and new contributing authors, this edition is an uptodate, easy. The goal of this chapter is to describe the pathophysiology of zenkers diverticulum, their clinical presentation, and indications for treatment and provide an overview of the surgical management of patients with this rare esophageal pathology. Source for the table information obtained from endoscopic staple diverticulostomy for zenker s diverticulum. It includes treatment guidelines approved by the two largest gastroenterology societies, the acg and asg. Zenkers diverticulum occurs when a pouch, also called a diverticulum, develops in the throat at the base of the neck. Zenkers diverticulum 7985 usual treatment is surgical the cricopharyngeus must be addressed during the time of operation.

The only treatment to cure zenker s diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. Zenkers diverticulumcausessymptomstreatmentdiagnosis. Zenkers diverticulum is a pouch that forms at the back of the throat at the junction of the pharynx and the esophagus the food passage to the stomach. In symptomatic recurrences, a second procedure was equally safe and effective in most patients. Surgical first assist practice exam flashcards quizlet. Poor upper esophageal sphincter ues compliance is the acknowledged pathophysiologic mechanism of action, leading to creation of a highpressure zone, ultimately resulting in diverticulum formation.

Called a zenkers myotomy, this surgical treatment is often combined with the complete removal of the sac zenkers diverticuletomy. Atlas of head and neck surgery delivers unparalleled visual guidance and insight to help you master the most important and cuttingedge head and neck procedures. Technique of open surgical procedure the operation is performed under general anesthesia. External diverticulectomy of a large recurrent zenkers diverticulum with mechanical stapler. This pouch typically causes problems by trapping food as it is being swallowed, leading to choking and aspiration. Although the treatment paradigm has shifted to minimally invasive approaches with endoscopic staplingassisted or laserassisted repair, traditional transcervical procedures can still play a role in selected cases. This surgical option typically takes about 15 to 30 minutes to complete.

Posted on feb 27, 2014 in alimentary tract, surgical techniques illustrated 2 comments. Zenker s diverticulum is a pseudodiverticulum of the esophagus that forms in the killian s triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older. Cardiac and thoracic surgeons specialize in the surgical treatment of diseases of. Zenker s diverticulum, cricopharyngeal myotomy, surgical complications, diverticulectomy. Jun 18, 2014 vogelsang a, preiss c, neuhaus h, et al. A tailored approach to the surgical treatment of zenkers.

Chassins operative strategy in general surgery by carol e. An expositive atlas is designed to expand this comprehensive and unique general surgery reference while remaining true to the special character of the work. Zenkers diverticulum zd is a posterior pharyngoesophageal mucosal outpouching that forms through killians triangle. It is a pulsion diverticulum that is likely the result of poor coordination between the pharyngeal and upper esophageal sphincter contractions at an area of anatomical weakness. With this technique, not only is a lateral neck incision avoided, but the patient is allowed to resume oral intake rapidly, usually within 24 hours of surgery. For a long time, surgical resection was the only treatment option in symptomatic zenkers diverticulum. The mortonbartley system classifies the diverticulum based on size with stage i. These diverticula are uncommon and tend to occur in elderly people. Pdf nursing approach to zenkers diverticulum surgery patient. Myotomy may be pursued through either open surgical or endoscopic techniques. Why would a zenkers diverticulum recur after surgical treatment. Ashley, provides the guidance you need to master these procedures used more frequently due to reduced patient risks, improved outcomes, and rapidly advancing technologies. The goal of this activity is to evaluate the diagnosis and management of zenkers diverticulum.