Successful completion of our course of studies meets the qualifying standards required to take the national certification examination for surgical technologies. 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. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. 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. There is a common wall that separates the esophagus from the diverticulum pouch. 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. Source for the table information obtained from endoscopic staple diverticulostomy for zenker s diverticulum. 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. Flexible endoscopic and surgical management of zenkers. Numerous and frequentlyupdated resource results are available from this search.
Endoscopic management of zenkers diverticulum practical. 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. An expositive atlas is designed to expand this comprehensive and unique general surgery reference while remaining true to the special character of the work. Different surgical techniques have been indicated for the management of zenkers diverticulum zd, including diverticulectomy.
Postoperative instructions following arizona sinus. The following are the presented options for the medical condition. Review of literature and experience in 159 consecutive cases. Diverticular resection, as well as a concomitant cricopharyngeal myotomy. Zenkers diverticulum uci head and neck surgery uci. Surgical options include a variety of tools and techniques and to accomplish some combination of diverticulectomy. Zenkers diverticulum 7985 usual treatment is surgical the cricopharyngeus must be addressed during the time of operation. Cardiac and thoracic surgeons specialize in the surgical treatment of diseases of. A barium swallow fluoroscopy allows your doctor to see how you swallow in motion. If you are wanting to access the uploaded articles linked below then you must be logged into portal. Flexible endoscopic zenkers diverticulotomy with a novel bipolar. Background the 2 most frequently used endoscopic methods to treat zenkers diverticulum are stapleassisted and co2 laser esophagodiverticulostomy.
Central ohio technical college hocking college surgical technology program welcome surgical technology students you are embarking on an exciting and challenging field of study. If the diverticulum is small, the preferred surgical technique is a minimally invasive approach in which the pouch is accessed through the mouth. In symptomatic recurrences, a second procedure was equally safe and effective in most patients. 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. A tailored approach to the surgical treatment of zenkers.
Surgical treatment of zenkers diverticulum springerlink. 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. The indication for surgical treatment was based on the severe dysphagia, which may cause in more than half of the patients, important weight loss. Chassins operative strategy in general surgery 4th. Zenkers diverticulum zd is an outpouching of tissue through killians triangle thought to be. Chassins operative strategy in general surgery 4th edition pdf. Called a zenkers myotomy, this surgical treatment is often combined with the complete removal of the sac zenkers diverticuletomy. Myotomy may be pursued through either open surgical or endoscopic techniques. 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. By the time these patients reach the surgeon, the diverticula have attained sufficient dimensions to warrant surgical excision in practically every instance. Management of zenker and hypopharyngeal diverticula.
Both are performed under general anesthesia with the patient asleep. This raphe suspends the pharynx from the base of skull at the pharyngeal tubercle, which is a palpable bump. 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. Why would a zenker s diverticulum recur after surgical treatment.
The fourth edition of chassins operative strategy in general surgery. 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. Little is a thoracic surgeon in oro valley, arizona. There are two common surgeries performed for treatment of zenker s diverticulum. Click here to jump down to questions about treatment. Distinguish the best imaging modality to diagnose zenkers diverticulum. Posted on feb 27, 2014 in alimentary tract, surgical techniques illustrated 2 comments. 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. Surgical experience of the national institution in the. Videoassisted thoracic surgery or vats is a surgical technique that involves insertion of a thorascope. He has written numerous publications as well as a book. Zenkers diverticulum clinical gastroenterology and hepatology. 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. Minimally invasive thoracic surgery or mits can be performed using video assistance or robotic assistance.
A tailored approach to the surgical treatment of zenkers diverticula. Cricopharyngeal myotomy remains a key element of surgical treatment of zenker diverticulum zd. External diverticulectomy of a large recurrent zenkers diverticulum with mechanical stapler. The trauma of the pharyngeal posterior wall occurs intraoperatively and can pass unnoticed. A zenker s diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle i. This surgery is performed by dr kanaan in mission viejo and irvine. 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. Ashley, provides the guidance you need to master these procedures used more frequently due to reduced patient risks, improved outcomes, and rapidly advancing technologies. Assess the clinical presentation of zenkers diverticulum. Atlas of minimally invasive surgical techniques ebook.
The bottom of the throat is surrounded by a muscle called the cricopharyngeus. The more common etiologies of dysphagia that lend themselves to surgical correction are described. The goal of this article is to illustrate our tailored approach to patients with. The surgical approach involves an external neck incision with cp myotomy diverticulotomy, with or without pouch intervention inversion. A comparative analysis article pdf available in otolaryngology head and neck surgery 1511 april 2014 with 512 reads how we measure reads. Atlas of advanced operative surgery 1st edition pdf free. Chassins operative strategy in general surgery by carol e. 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. A single lumen tracheal tube is inserted into the esophageal lumen to serve as a stent. 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. That is why a diverticulectomy alone is not performed, because the underlying problem will not be addressed. Thieme ejournals endoscopy international open full text. 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. Atlas of minimally invasive surgical techniques, by drs.
Sometimes, other conditions are present alongside zenker s. Diverticulum treatment surgical techniques illustrated. Expanded to 4 chapters and enhanced by new color photos and new contributing authors, this edition is an uptodate, easy. There are a number of surgical interventions for zenkers diverticulum. Combination of surgical and endoscopic approach for zenkers.
Outcomes favoring the stapler technique included a shorter duration of nil per os npo status 2 studies, length of. Endoscopic treatment of zenkers diverticulum by carbon dioxide laser. 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. 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. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. For a long time, surgical resection was the only treatment option in symptomatic zenkers diverticulum. The endoscopic stapling technique has revolutionized the treatment of zd. Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenkers diverticulum. General surgery clerkship curriculum declare the past, diagnose the present, and foretell the future. Scottconner, 97814614929, available at book depository with free delivery worldwide.
This happens when there is pressure on your pharynx and it balloons out. In 1958, harrison added myotomy in the surgical protocol of zenker diverticulum 11,12. Pharyngoesophageal zenkers diverticulum is a false diverticulum of the cervical esophagus. Some neurologic diseases, such as a stroke, may result in malfunctioning of the cricopharyngeal muscle. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The surgeon then uses a surgical stapler or laser to cut the cricopharyngeus muscle. Jun 18, 2014 vogelsang a, preiss c, neuhaus h, et al. More than 50% of the affected patients present in 6080 years of life. 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.
Endotherapy of zenkers diverticulum using the needleknife technique. 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. Endoscopic pharyngoesophageal zenkers diverticulostomy. The diverticulum can frequently be the etiology for aspiration and pneumonia and should therefore be repaired in patients capable of tolerating the operative procedure. All 3 constrictors pass around and insert into a midline raphe on the posterior pharynx and vary in where they originate. 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.
It includes treatment guidelines approved by the two largest gastroenterology societies, the acg and asg. 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 only treatment to cure zenker s diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. Edited by eugene myers, charles bluestone, derald brackman, charles krause. Endoscopic stapling technique for the treatment of zenker. It\u2019s time to grab a copy of master techniques in surgery. 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.
When food and saliva fill up the pouch, however, symptoms can occur and may include. Surgery for zenker s diverticulum involves cutting the cricopharygues muscle. Because of the delicate architecture of the vocal folds, highlyskilled surgery is required to restore vibration to the vocal fold. In summary, if the zenker s diverticulum is causing aspiration, i would recommend surgical treatment. Surgery may be indicated for some vocal fold lesions. Visualize every procedure thanks to more than 1,000. Several classification systems for zenkers diverticulum have been proposed including the brombart and the morton bartley systems.
The surgical procedure of choice in patients with symptomatic zenkers. Zenkers diverticulumcausessymptomstreatmentdiagnosis. Endoscopic stapling is the currently preferred treatment for zenkers diverticulum, i. It is a pseudo diverticulum not involving all layers of the esophageal wall. Surgical treatment of zenkers diverticulum fulltext digestive.
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. Operative dictations in general and vascular surgery. A simple technique to improve external surgical treatment of zenkers diverticulum is presented. The unit carries out diagnosis and treatment of benign diseases of the esophagus and gastroesophageal junction.
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. Fibreoptic diverticular repair is another of the methods for treating ze. Minimally invasive thoracic surgery mission viejo vat. Zenkers diverticulectomy open approach iowa head and. Endoscopic versus surgical approach in the treatment of zenkers. Technique of open surgical procedure the operation is performed under general anesthesia. 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. Orientation of the parts thereby becomes more challenging. The use of opencell foam and elastic foam tape as an effective and convenient skin simulator for teaching suturing technique. It is the most common type of oesophageal diverticula with a reported prevalence ranging between 0. Atlas of advanced operative surgery 9781416041092 us.
Concise yet complete, this easily accessible text captures groundbreaking techniques such as videoassisted thyroid and parathyroid surgeries. Zenker s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. Koch m, mantsopoulos k, velegrakis s, iro h, zenk j. Malfunctioning of the cricopharyngeal muscle with aging seems to be the main cause. A zenkers diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle i. Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older. A rigid esophageal endoscopy is performed just before the operation.
Surgical first assist practice exam flashcards quizlet. Head and neck surgery, 3volume set, edition 5 ebook written by paul w. 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. Endoscopic treatment, although frequently performed, has not replaced the open cricopharyngeal myotomy, which is still deemed the standard therapy by many dedicated physicians. Zenkers diverticulum southern california, orange county. Zenkers diverticulum zd is a posterior pharyngoesophageal mucosal outpouching that forms through killians triangle. Oclcs webjunction has pulled together information and resources to assist library staff as they consider how to handle. Zenkers diverticulumminimally invasive treatment by. 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. Zenkers diverticulum an overview sciencedirect topics. A zenker s diverticulum is a pouch located in the back of the throat that causes difficulty swallowing. Baron also discusses traditional surgical management, as well as endoscopic treatment of zenker s diverticulum. Apr 04, 2014 surgical techniques for zenkers diverticulum.
Zenkers diverticulum occurs when a pouch, also called a diverticulum, develops in the throat at the base of the neck. This book is distributed under the terms of the creative commons. Zenkers diverticulectomy southern california, orange. Principles of surgical treatment of zenker diverticulum. It was followed by an otolaryngeal intraluminal technique with the dissection of the bridge that separates the diverticulum from the esophageal lumen. 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.
This pouch typically causes problems by trapping food as it is being swallowed, leading to choking and aspiration. 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. Posted on mar 25, 2014 in surgical techniques illustrated 4 comments.
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. Advances in otolaryngologyhead and neck surgery, vol i. Extraesophageal reflux in patients suffering from zenker s diverticulum. Surgery for pharyngeal pouch zenkers diverticulum english, cricopharyngeal myotomy surgical technique. Comparing different surgical approaches for zenkers diverticulum. Endoscopic pharyngoesophageal diverticulostomy is performed to address an abnormal pouch diverticulum that originates above a constriction at the entrance to the esophagus. This is known in the 70s as the first surgical intervention for zenkers diverticulum. Zenkers diverticulum uci head and neck surgery uci ent. Zenkers diverticulum location, symptoms, treatment, diet. Advance your surgical expertise with atlas of advanced operative surgery.
Zenker s diverticulum, cricopharyngeal myotomy, surgical complications, diverticulectomy. A barium swallow is a special xray that highlights the inside of your mouth, pharynx, and esophagus. The sixth edition of the esophagus also explores the diagnosis and treatment of various esophageal conditions. Therapy of symptomatic zd has evolved from an open surgical approach to less invasive transoral endoscopic techniques. May 25, 2017 your doctor may consider surgical options depending on the location and if you have a more severe case. The management of the diverticular sac after myotomy is still a matter of debate. This surgical option typically takes about 15 to 30 minutes to complete.
Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal disorder with an annual incidence of just 2 per 100,000. Pdf nursing approach to zenkers diverticulum surgery patient. Zenkers diverticulum repair what is zenkers diverticulum. Dec 14, 2016 surgical treatment of zenkers diverticulum.
The mortonbartley system classifies the diverticulum based on size with stage i. Reliable information about the coronavirus covid19 is available from the world health organization current situation, international travel. 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. A further advantage is the decreased morbidity associated with this technique. Upon completion of this activity, participants will be able to. Zenker s diverticulum is diagnosed using a test called a barium swallow. As a consequence of this, the learning curve for this technique. A zenkers diverticulectomy three procedures have been described to treat a zenkers diverticulum.
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. Why would a zenkers diverticulum recur after surgical treatment. Cummings otolaryngology head and neck surgery e book. 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. Essential operative techniques and anatomy, 4eand its accompanying online component. Cricopharyngeal myotomy an overview sciencedirect topics. 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.
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. Todd baron defines zenker s diverticulum and its symptoms. Apr 3, 2017 the main cause of zenkers diverticulum is thought to be malfunctioning of the cricopharyngeal muscle due to the aging process. Why would a zenkers diverticulum recur after surgical. The ideal surgical technique for symptomatic zenkers diverticulum has not been identified yet. 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. The goal of this activity is to evaluate the diagnosis and management of zenkers diverticulum.
The advent of endoscopic techniques has transformed the surgical therapy of zenkers diverticula. The diagnosis was based on a clinical picture severe dysphagia, regurgitations, weight loss and investigations barium passage, upper endoscopy. This endoscopic technique consists of a transoral surgical procedure that divides the septum party wall between the zd and the cervical. Start studying surgical first assist practice exam. 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. Minimally invasive approach revolutionizes lung cancer surgery. Zenkers diverticulum is a type of diverticulum that develops in the. Surgical statistics were published during 20012011, including a group of 11 patients 5 men, that underwent surgical treatment for zenker diverticulum.
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