Diverticulopexy and cricopharyngeal myotomy: treatment for the high-risk patient with a pharyngoesophageal (Zenker's) diverticulum.

Although diverticulopexy for the treatment of Zenker's diverticulum was described more than 75 years ago, its use has been infrequently reported in the surgical literature. Between 1974 and 1987, thirty-two patients manifested dysphagia caused by a pharyngoesophageal diverticulum. Twelve patients underwent diverticulopexy with cricopharyngeal myotomy, whereas the others had a one-stage resection of the diverticulum with myotomy. Complications of diverticulectomy were rare, but included an instance of esophageal leak, which responded to conservative therapy. Despite this low complication rate, diverticulopexy with myotomy was used in patients who possessed risk factors that made them unsuitable candidates for diverticulectomy. These factors included a debilitated state from effects of the diverticulum, a history of postsurgical complications, multiple medical illnesses, advanced age with inability to ambulate, and insulin-dependent diabetes mellitus. A nasogastric tube was not necessary after diverticulopexy. This allowed oral intake on the first postoperative day, immediate ambulation, and a shorter hospital stay. Objective recurrence occurred in one patient who underwent diverticulopexy and myotomy caused by manipulation of the sac during a subsequent surgical procedure, but significant dysphagia did not occur. Thus, although diverticulectomy has proved to be a relatively safe procedure, diverticulopexy with cricopharyngeal myotomy is recommended for high-risk patients in whom potential complications from diverticulum excision and prolonged hospitalization could be devastating.