Surgery for dysphagia: a patient centered perspective

Abstract

Pharyngeal pouch, also known as Zenker’s diverticulum, is an uncommon cause of dysphagia with an estimated incidence of 1:100,000 (1,2). The condition was first described by Ludlow in 1769 and then again in 1877 with a case series of 34 patients by Zenker and his colleague Von Ziemssen (3). Pharyngeal Pouches are an outpouching of mucosa and submucosa through an area of weakness in the posterior pharyngeal wall between the cricopharyngeus muscle and the oblique fibers of the inferior pharyngeal constrictor muscle. There is no clear consensus on the exact pathophysiology underlying this disorder although several hypotheses have been generated (1-8). Historically treatment of a pharyngeal pouch has been via a transcervical cricopharyngeal myotomy and resection or pexy of the diverticulum (3). An endoscopic approach is now the more frequently employed technique, either with the use of an endostapler or with a variety of other endoscopic tools including laser, diathermy or simple sharp division of the common wall of the diverticulum. The open approach is typically reserved for recurrent pouches or those patients who are unsuitable for an endoscopic approach. The rational behind the increased use of the endoscopic approach is shorter operative time, less extensive surgery and shorter hospital stays with similar rates of complications overall (2,4,7,9-12). Much of the research has aimed to delineate operative techniques in terms of feasibility, operative time, length of hospital admission, post-operative complications and rates of recurrence. However, there is a lack of original Original Article