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General Surgery

Program Director:
Hines, Joe M.D.

Contact Phone Number
1-800-825-2888

Description of Clinical Program
Treatment of Zenkerís Diverticula by Cricopharyngeus Myotomy Under Local Anesthesia


Program News UCLA general surgeons perform cricopharyngeus myotomy under local anesthesia as a complete treatment for Zenkerís Diverticula with good results.

Significance The incidence of Zenkerís diverticulum is increasing parallel with the rising number of elderly patients in the United States.
These patients suffer the consequences of aspirating saliva and undigested food, sequestration and regurgitation of medications, and esophageal obstruction. The condition often leads to malnutrition and pulmonary complications.
Diagnosis of Zenkerís diverticulum is easily made using the technique of contrast esophagography.
Treatment has traditionally focused on obliteration of the diverticulum.
Surgeons have practiced a combined procedure, adding cricopharyngeus myotomy to resection or fixation of the sac which decreased the recurrence rate. However, complications of resection include suture line leak, fistula, and mediastinitis.
UCLA surgeons have studied the long-term outcome of treating patients with upper esophageal sphincter (UES) myotomy only with excellent results.

Application All patients with dysphagia and demonstrable diverticulum should be considered for definitive surgical correction of the lesion. It is generally agreed that treatment requires division of the cricopharyngeus muscle.
The patient remains awake for the procedure during which he is asked to swallow, thus helping the surgeons to precisely identify the entire length of the UES, and completely and accurately divide the cricopharyngeus muscle.
Rarely is more than 20 cc of lidocaine hydrochloride required to complete this procedure.
Upon completion of the myotomy, the bulging sac will decompress to less than half of the initial size; subsequently, swallowing no longer balloons the sac outward.
The procedure has occasionally been performed in an outpatient setting.
Patients with end-stage diverticula can also benefit from a two-stage approach, also under local anesthesia. This approach involves myotomy and a lateral esophagostomy.
The results of the study suggest:
The effective treatment of the hypopharyngeal diverticulum of any size is dependent on a complete myotomy of the UES. Leaving the diverticulum in situ does not detract from the satisfactory relief of dysphagia.
This method is associated with minimal morbidity and allows earlier resumption of a regular diet.
Performance of the procedure under local anesthesia improves the accuracy and completeness of the myotomy as well as enabling this procedure to be performed with relative safety on the elderly patient whose respiratory system is compromised.

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