Zenker’s Diverticulum Repair

A Zenker’s diverticulum is a pouch that develops in the lower throat (hypopharynx) just above the upper esophageal sphincter (UES).  Food may become trapped there, causing difficulties in swallowing, bad breath, regurgitation, chronic coughing and irritation.  They are generally categorized as small, intermediate, or large in size. They extend into the left side of the neck 90% of the time due to a slight convex shape of the esophagus to that side and the presence of a potential space there.  The cause of this problem is believed to be due to cricopharyngeal spasm, which is the main muscle at the upper esophageal sphincter (UES).  In the past the treatment of this difficult problem was an open surgical procedure where a incision is made in the left neck and the pouch is excised in the hypopharynx.  Then the hole that is left behind is meticulously closed in layers.  A feeding tube is placed to bypass the area of repair and the patient is kept in the hospital for 5-7 days on a feeding tube until the area has completely healed.

More recently a new approach to this problem termed endoscopic zenker’s diverticulectomy has come about.  Dr. Alen Cohen in Los Angeles is one of only a few surgeons in the country who routinely performs endoscopic zenker’s diverticulectomy with excellent success rates without the need to convert to an open procedure. In this procedure a special scope is inserted through the mouth and the pouch in the hypopharynx is identified.  Once identified a special stapler is used to cut the party wall between the pouch and esophagus which then resolves the problem.  The patient is kept overnight and sent home the next day on a soft diet.