Skip to main content
SpringerLink
Log in

Zenker-Divertikel: Pro Operation

Zenker’s diverticulum: pro operation

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Beim Zenker-Divertikel ist die Indikation zur Behandlung mit der Indikationsstellung gegeben, wobei das Behandlungsziel in der Beseitigung der Dysphagie und der Retentionssymptome sowie der Vermeidung von Rezidiven besteht. Derzeit bestehen drei unterschiedliche Behandlungsoptionen: Neben der klassischen zervikalen Myotomie mit Divertikulektomie/Divertikulopexie werden die transorale Schwellenspaltung mit dem Linearstapler oder die flexibel-endoskopische Schwellenspaltung mit dem Nadelmesser o. ä. propagiert. Im Vergleich zur klassischen offenen Operation sind die beiden Verfahren der transoralen Schwellenspaltung weniger invasiv. Sie kommen allerdings nicht für alle Ausprägungsgrade in Betracht und sind mit einer hohen Rezidivquote belastet. Für Patienten mit noch höherer Lebenserwartung und gegebener Operationsfähigkeit ist deshalb die Divertikulektomie zu empfehlen.

Abstract

In case of Zenker’s diverticulum, treatment is indicated as soon as the diagnosis is established. Therapy should aim at the elimination of dysphagia and the symptoms of food retention and should reliably prevent recurrence. Currently, three different therapeutic approaches are applied: the classical option is open transcervical myotomy and diverticulectomy/diverticulopexy and alternatively stapled diverticulostomy with a linear stapler or flexible endoscopic diverticulostomy is propagated. As compared to the surgical (open) approach, rigid or flexible endotherapy is less invasive. However, endotherapy is not always feasible for all types of Zenker’s diverticulum and the recurrence rate is high. Accordingly, open diverticulectomy is recommended in patients with an adequate life expectancy and good general operability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Barthlen W, Feussner H, Hannig C et al (1990) Surgical therapy of Zenker‘s diverticulum: low risk and high efficiency. Dysphagia 5(1):13–19

    Article  PubMed  CAS  Google Scholar 

  2. Benjamin B, Gallagher R (1993) Microendoscopic laser diverticulotomy for hypoharyngeal diverticulum. Ann Otol Rhinol Larngol 102:675–679

    CAS  Google Scholar 

  3. Bonavina L, Bona D, Abraham M et al (2007) Long-term results of endosurgical and open surgical approach for Zenker diverticulum. World J Gastroenterol 13(18):2586–2589

    PubMed  Google Scholar 

  4. Bradley PJ, Kochaar A, Quaraishi MS (1999) Pharyngeal pouch carcinoma: real or imaginary risks? Ann Otol Rhinol Laryngol 108:1027–1032

    PubMed  CAS  Google Scholar 

  5. Brombart MM (1980) Radiologie des Verdauungstraktes: Funktionelle Untersuchung und Diagnostik (Teil 3). Thieme, Stuttgart New York

  6. Collard JM, Otte JB, Kestens PJ (1993) Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thorac Surg 56(3):573–576

    Article  PubMed  CAS  Google Scholar 

  7. Dohlman G, Mattsson O (1960) The endoscopic operation for hypopharyngeal diverticula: a roentgencinematographic study. AMA Arch Otolaryngol 71:744–752

    PubMed  CAS  Google Scholar 

  8. Feussner H (1995) Reducing treatment of Zenker’s Diverticulum to the essentials: the flexible endoscopic approach. Endoscopy 27(6):445

    Article  PubMed  CAS  Google Scholar 

  9. Feussner H (2007) Endoscopic therapy for Zenker diverticulum – the good and the bad. Endoscopy 39(2):154–155

    Article  PubMed  CAS  Google Scholar 

  10. Feussner H, Siewert JR (1999) Traditionelle extraluminale Operation des Zenker-Divertikels. Chirurg 70(7):753–756

    Article  PubMed  CAS  Google Scholar 

  11. Flikweert DC, van der Baan S (1992) Endoscopic treatment of pharyngeal pouches. Clin Otolaryngol 17:122–124

    Article  PubMed  CAS  Google Scholar 

  12. Hecker A, Junginger T (1996) Zervikale Ösophagusdivertikel – perioperative Risiken und Langzeitverlauf. Zentralbl Chir 121:201

    PubMed  CAS  Google Scholar 

  13. Hugh TB (2009) Surgical sense and legal non-sense – Chappel v Hart revisited. ANZ J Surg 79:554–557

    Article  PubMed  Google Scholar 

  14. Ishioka S, Sakai P, Maluf Filho F, Melo JM (1995) Endoscopic incision of Zenker‘s diverticula. Endoscopy 27(6):433–437

    Article  PubMed  CAS  Google Scholar 

  15. Mosher HP (1917) Webs and pouches of the esophagus: their diagnosis and treatment. Surg Gynecol Obstet 25:175–187

    Google Scholar 

  16. Mulder CJ, den Hartog G, Robijn RJ, Thies JE (1995) Flexible endoscopic treatment of Zenker‘s diverticulum: a new approach. Endoscopy 27(6):438–442

    Article  PubMed  CAS  Google Scholar 

  17. Ochando Cerdàn F, Gonzales ME (1998) Diagnostic and treatment of Zenker’s diverticulum: review of our series pharyngo-esophageal diverticula. Hepatogastroenterology 45:447

    Google Scholar 

  18. Omote K, Feussner H, Stein HJ et al (1999) Endoscopic stapling diverticulostomy for Zenker’s diverticulum. Surg Endosc 13(5):535–538

    Article  PubMed  CAS  Google Scholar 

  19. Rizzetto C, Zaninotto G, Costantini M et al (2008) Zenker’s diverticula: feasibility of a tailored approach based on diverticulum size. J Gastrointest Surg 12:2057–2065

    Article  PubMed  Google Scholar 

  20. Wasserzug O, Zikk D, Raziel A et al (2010) Endoscopically stapled diverticulostomy for Zenker’s diverticulum: results of a multidisciplinary team approach. Surg Endosc 24:637–641

    Article  PubMed  Google Scholar 

  21. Yeo JC, Mackenzie K (2010) Pharyngeal pouch surgery in north Glasgow: NICE (National Institute for Health and Clinical Excellence) practice or not? J Laryngol Otol 124(5):533–537

    Article  PubMed  CAS  Google Scholar 

  22. Siewert JR (2007) Chirurgie. 8. Aufl. Springer, Berlin Heidelberg

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar TU München, Ismaninger Str. 22, 81675, München, Deutschland

    H. Feußner

Authors
  1. H. Feußner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Feußner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feußner, H. Zenker-Divertikel: Pro Operation. Chirurg 82, 484–489 (2011). https://doi.org/10.1007/s00104-010-2037-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-010-2037-9

Schlüsselwörter

Keywords

Search

Navigation