The goal of surgical treatment is to restore the continuity from the hypopharynx to the esophageal lumen without obstruction or retention of swallowed contents. 5 Additionally, upper endoscopy is recommended to confirm the diagnosis and rule out possible malignancy. A definitive diagnosis requires visualization of the diverticulum by showing a contrast-filled pouch that is best detected using lateral projection. Diagnosis and Imagingĭiagnosis is made by correlating the patient’s history and clinical findings with imaging studies, such as a barium or gastrografin esophagram. ZD can be found incidentally in patients who undergo upper endoscopy for other reasons, but surgical intervention should be reserved for symptomatic patients. The most serious consequence of ZD is the pulmonary aspiration, and patients may present with a history and typical signs of aspiration pneumonia. However, physical exam findings are often unremarkable. Swallowed contents can become lodged within the diverticulum and cause halitosis and further outpouching, possibly leading to the appearance of a neck mass on physical examination. Weight loss can be reported due to the distress caused by eating. Other associated symptoms can include retrosternal pressure sensation, halitosis, and regurgitation of undigested food. For patients who develop symptoms, the most common presenting symptom of ZD is dysphagia. 4, 5 Patient History and Physical Examination The pathophysiology of ZD is unclear however, certain risk factors such as abnormal esophageal motility, altered upper esophageal sphincter function, and aging predispose patients to its development. 3 ZD has a higher prevalence in the USA, Canada, and Australia compared with Japan and Indonesia. The overall prevalence of ZD is believed to be between 0.01–0.11%. 2 ZD protrudes through Killian’s triangle, which is an area of least resistance between the oblique fibers of the inferior pharyngeal constrictors and the cricopharyngeus (CP) muscle. Zenker’s diverticulum (ZD) is the most common type of esophageal diverticula, typically presents in patients older than 70 years of age, 1 and is slightly more common in males. The clinical presentation, diagnostic criteria, surgical procedure, and postoperative care are highlighted. We present a case of a patient with a symptomatic ZD that is treated with an endoscopic staple-assisted diverticulotomy. Thus, endoscopic access is often considered the first-line choice for the treatment of ZD. Endoscopic approaches have gained widespread acceptance due to shorter hospital stays, lower rates of complications, ease of access in case of recurrence, and shorter operation times. The open surgical approach involves a transcervical incision usually involving concurrent cricopharyngeal (CP) myotomy, whereas the endoscopic utilizes an endoscope to visualize and divide the diverticulum from the inside. The definitive treatment for symptomatic Zenker’s diverticulum is a surgical correction, either by an open transcervical or an endoscopic approach. ZD can be asymptomatic, and the most common symptom associated with symptomatic ZD is dysphagia. ZD is likely caused by incomplete relaxation of the upper esophageal sphincter as well as increased intraluminal pressure. ![]() Tri-Staple™ reloads have some fundamental differences to legacy technology that brings a host of clinical advantages for you and your patients.Zenker's diverticulum (ZD) results from a posterior mucosal herniation through Killian’s triangle, an area situated above the cricopharyngeus (CP) muscle and below the inferior pharyngeal constrictor muscle. ![]() Tri-Staple™ technology is a proprietary Medtronic stapling innovation which in recent years has transformed endoscopic stapling and is now set to do the same in open procedures. That means more security (,), (,), (,) ,†,‡ and a potential for greater perfusion at the staple line (,), (,) ,†,§ Circular stapling now comes with Tri-Staple™ technology.
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