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Comparing Different Surgical Approaches Treating Zenker's Diverticulum

by , last modified on 4/14/21.

Table below summarizes the outcomes when comparing the different surgical approaches in treating Zenker's Diverticulum. ESD is Endoscopic Staple Diverticulostomy which is what we advocate. Endoscopic CO2 laser uses a similar approach, but a laser is used to divide the common wall instead of a stapling device. Open transcervical approach is performed through an incision in the neck instead of going through the mouth endoscopically.

There are other new surgical procedures being developed, but not enough data to provide adequate statistical numbers. Such newer approaches include the Trans-Oral Resection of Diverticula (TORD) which specifically addresses small Zenker's Diverticulum (which ESD is not good at addressing) as well as flexible instead of rigid endoscopic approach.

 
ESD
Endoscopic CO2 Laser
Open Transcervical Approach
Time Under Anesthesia
< 45 minutes
> 60 minutes (several sessions not uncommon)
83.2 minutes
Days Before Being Allowed to Eat/Drink
< 1 day
2.2 days
4.5 days
Days of Hospitalization
< 1 day
6.5 days
7.6 days
Complication Rate
2.6%
7.4%
11.8%
Recurrence Rate
6%
11.5%
5%
Risks Resulting in a Surgical Complication
  • Esophageal Perforation
  • Mediastinitis
  • Cervical Abscess
  • Chipped Teeth
  • Aspiration Pneumonia
  • Transient Vocal Cord Paralysis
  • Recurrence
  • Esophageal Perforation
  • Mediastinitis
  • Cervical Abscess
  • Chipped Teeth
  • Aspiration Pneumonia
  • Airway Fire
  • Oral/Facial Burns
  • Recurrence
  • Esophageal Perforation
  • Mediastinitis
  • Cervical Abscess
  • Aspiration Pneumonia
  • Bleeding
  • Hematoma
  • Nerve Injury
Who is a candidate?
Works best for pouches >1.5cm in size
Works for pouches of any size
Works for pouches of any size


Source for the table information obtained from "Endoscopic Staple Diverticulostomy for Zenker's Diverticulum: Review of Literature and Experience in 159 Consecutive Cases. Laryngoscope. 113(6):957-965, 2003. Link"

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