Zenker's diverticula.

Zenker's diverticula, or hypopharyngeal diverticula, have a multifactorial etiology including both mechanical and structural factors. The diagnosis of the diverticula is based on an accurate history and physical examination and is confirmed with contrast radiography. Historically, the management of Zenker's diverticula has been controversial. Nonetheless, if the patient is symptomatic, surgical management is indicated. Surgical procedures include cricopharyngeal myotomy, diverticulopexy, diverticulum resection, and endoscopic diathermy (the Dohlman procedure). Each has its proponents and each has its disadvantages and complication rates. The decision as to which procedure to use hinges on clinical factors such as the patient's age, general state of health, and whether or not the lesion is recurrent. The pathophysiology of Zenker's diverticula is discussed with special reference to the anatomy of the hypopharynx. The evaluation of these patients is reviewed, as are some of the current surgical approaches employed when treating Zenker's diverticula.