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A diverticulum can form in the cervical, or upper portion of the esophagus as a consequence of dysfunction of the cricopharyngeus muscle. Typically, patients experience dysphagia, regurgitation or aspiration, and halitosis, or bad breath. The traditional approach to surgical correction of this problem involves an incision in the neck with a myotomy of the cricopharyngeus muscle, and either suspension or removal of the diverticulum.
However, a new approach offered at USC by the Thoracic/Foregut surgeons is a transoral, or through the mouth, approach. With this approach no incision is made. Instead, a specially designed instrument is passed down the mouth and the diverticulum demonstrated. Subsequently, a modified stapling device is passed through the mouth and myotomy of the muscle and elimination of the pouch are accomplished simultaneously by using the stapler to open the bridge, or shelf, between the diverticulum and the patient's esophagus. With no incision recovery is very rapid, and results are excellent.
For more information contact us at chestsurgery@surgery.usc.edu.
 Above: The transoral device has been inserted and the lower blade is within the Zenker's diverticulum while the upper blade is within the normal esophageal lumen. The ridge represents the cricopharyngeus muscle.  Above: Sutures have been temporally placed in the cricopharyngeal muscular ridge to facilitate insertion and division of the muscle with the stapling device.  Above: The modified stapling device has been inserted and is in position ready to fire and divide the cricopharyngeus muscle.  Above: The stapler has been fired and the cricopharyngeus divided. The staples can be seen as well as the disruption of the cricopharyngeal muscular bar which now allows the diverticulum to become a common cavity with the normal esophageal lumen. This procedure accomplishes the two main goals of Zenker's diverticulum surgery: 1) Disruption of the abnormal cricopharyngeus muscle, and 2) elimination of the actual pouch. Following this procedure patients note significant improvement in their swallowing and an end to regurgitation of contents that had previously built up within the pouch. |
