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Zenker diverticulum: Experience in surgical treatment of large diverticula.

Abstract The purpose of this retrospective study is to show that transcervical diverticulectomy (TD) in treatment of Zenker diverticulum (ZD) can still be a first choice procedure in selected patients and in experienced hands its safety might be compared to the minimally invasive endoscopic diverticulostomy.The study cohort consisted of 44 patients (18 male, 26 female) operated for (ZD). All the patients underwent open diverticulectomy. The decision to choose open surgical repair depended on surgical risk, age of the patient, size of the diverticular septum (the distance between the top of the diverticulum and its bottom on barium study), and patient's preference.Mean age of patients was 64.6 ± 11.9 years; range: 26 to 88 years. A total of 36.4% out of them finished 70 years. Postoperative mortality was nil. Two major complications (4.5%) requiring surgical intervention occurred: leak and hematoma.Data were analyzed by t test for independent samples using Statistica 12.5 software. P value <0.05 was considered statistically significant.Surgical treatment of patients with ZD should be individualized. Large Zenker diverticula with the septum longer than 6 cm should preferably be resected through an open approach because it is not possible to remove the septum completely during one-step endoscopic procedure and diverticulostomy creates a weak and large common cavity in the esophagus. Surgical repair is effective for all sizes of diverticula, but its most serious complications such as leakage or laryngeal nerve injury should be considered, especially in elderly patients with comorbidities. However, age alone should not be the main criterion if choosing the treatment option.
PMID
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Authors

Mayor MeshTerms

Esophagus

Hematoma

Zenker Diverticulum

Keywords
Journal Title medicine
Publication Year Start




PMID- 29742690
OWN - NLM
STAT- MEDLINE
DCOM- 20180515
LR  - 20180515
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 19
DP  - 2018 May
TI  - Zenker diverticulum: Experience in surgical treatment of large diverticula.
PG  - e0557
LID - 10.1097/MD.0000000000010557 [doi]
AB  - The purpose of this retrospective study is to show that transcervical
      diverticulectomy (TD) in treatment of Zenker diverticulum (ZD) can still be a
      first choice procedure in selected patients and in experienced hands its safety
      might be compared to the minimally invasive endoscopic diverticulostomy.The study
      cohort consisted of 44 patients (18 male, 26 female) operated for (ZD). All the
      patients underwent open diverticulectomy. The decision to choose open surgical
      repair depended on surgical risk, age of the patient, size of the diverticular
      septum (the distance between the top of the diverticulum and its bottom on barium
      study), and patient's preference.Mean age of patients was 64.6 +/- 11.9 years;
      range: 26 to 88 years. A total of 36.4% out of them finished 70 years.
      Postoperative mortality was nil. Two major complications (4.5%) requiring
      surgical intervention occurred: leak and hematoma.Data were analyzed by t test
      for independent samples using Statistica 12.5 software. P value &lt;0.05 was
      considered statistically significant.Surgical treatment of patients with ZD
      should be individualized. Large Zenker diverticula with the septum longer than 6 
      cm should preferably be resected through an open approach because it is not
      possible to remove the septum completely during one-step endoscopic procedure and
      diverticulostomy creates a weak and large common cavity in the esophagus.
      Surgical repair is effective for all sizes of diverticula, but its most serious
      complications such as leakage or laryngeal nerve injury should be considered,
      especially in elderly patients with comorbidities. However, age alone should not 
      be the main criterion if choosing the treatment option.
FAU - Tabola, Renata
AU  - Tabola R
AD  - Department of Gastrointestinal and General Surgery, Medical University of
      Wroclaw, Wroclaw, Poland.
FAU - Lewandowski, Andrzej
AU  - Lewandowski A
AD  - Department of Gastrointestinal and General Surgery, Medical University of
      Wroclaw, Wroclaw, Poland.
FAU - Cirocchi, Roberto
AU  - Cirocchi R
AD  - Department of General and Oncological Surgery, University of Perugia, Perugia,
      Italy.
FAU - Augoff, Katarzyna
AU  - Augoff K
AD  - Department of Gastrointestinal and General Surgery, Medical University of
      Wroclaw, Wroclaw, Poland.
FAU - Kozminska, Urszula
AU  - Kozminska U
AD  - Department of Radiology.
FAU - Strzelec, Bartlomiej
AU  - Strzelec B
AD  - Faculty of Medicine, Medical University of Wroclaw, Wroclaw, Poland.
FAU - Grabowski, Krzysztof
AU  - Grabowski K
AD  - Department of Gastrointestinal and General Surgery, Medical University of
      Wroclaw, Wroclaw, Poland.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Aged
MH  - Anastomotic Leak/*diagnosis
MH  - Comparative Effectiveness Research
MH  - Esophagectomy/adverse effects/methods
MH  - Esophagoscopy/*methods
MH  - *Esophagus/pathology/surgery
MH  - Female
MH  - *Hematoma/diagnosis/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/adverse effects/methods
MH  - Neck/surgery
MH  - Outcome and Process Assessment (Health Care)
MH  - Poland
MH  - Retrospective Studies
MH  - *Zenker Diverticulum/diagnostic imaging/pathology/surgery
EDAT- 2018/05/10 06:00
MHDA- 2018/05/16 06:00
CRDT- 2018/05/10 06:00
PHST- 2018/05/10 06:00 [entrez]
PHST- 2018/05/10 06:00 [pubmed]
PHST- 2018/05/16 06:00 [medline]
AID - 10.1097/MD.0000000000010557 [doi]
AID - 00005792-201805110-00009 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(19):e0557. doi: 10.1097/MD.0000000000010557.