Journal de Chirurgie Viscérale – Vol. – N° 4 – p. – Diverticulopexie pour diverticule de Zenker – EM|consulte. A Zenker’s diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, also hypopharyngeal diverticulum, is a diverticulum of the mucosa of. Keywords: Zenker, esophageal diverticulum, diverticulectomy, .. M. Diverticule pharyngo- oesophagien de zenker a propos de cinq cas.
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Zenker, esophageal diverticulum, diverticulectomy, diverticulopexy. A year-old woman, with a previous history of a “psychological xe disorder”, was referred to the Emergency Department. Subsequently the patient undergoes a diverticulectomy through a right thoracoscopic approach.
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Ann R Coll Surg Engl. Upper Hematemesis Melena Lower Hematochezia. Killian’s diverticulum is formed in the Killian-Jamiseon triangle located inferior to the cricopharyngeus on both sides of this muscle’s insertion into the cricoid cartilage.
The diagnosis is suspected based on clinical symptoms and easily confirmed by djverticule studies available almost everywhere barium passage and upper endoscopy. Microlaryngoscopic repair of iatrogenic pharyngeal pouch perforations: Specific Considerations, Chapter This procedure does not require the opening of the esophageal mucosa, reducing the risk of developing fistula or stenosis, but includes myotomy.
All the patients included in the study underwent surgical treatment.
CO2 laser versus endoscopic stapling”. The simple approach of the diverticular pouch through diverticulectomy or diverticulopexy is insufficient, the therapeutic protocol imposes the interception of etiologic mechanisms, esophageal myotomy distal to the diverticular opening being indispensable. We have routinely performed esophageal myotomy, distal to the diverticular opening, regardless of the manometry findings or the intraoperative aspect of the muscular layer.
Specific complication is the perforation during the use of the stapler, the management of this complication implying conversion to open surgery and diverticulectomy [ 31 ].
In simple words, when there is excessive pressure within the lower pharynxthe weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.
Diverticulopexie pour diverticule de Zenker – EM|consulte
The technique permits the patient to resume oral feeding on the second postoperative day [ 15 ]. Other non-surgical treatment modalities also exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.
Sincewhen Ludlow had made the first description of the surgical treatment that was reported by Zenier indifferent therapies for Zenker diverticulum were imagined. The septum is cut by using linear endostapler of 35 mm EndoGIAcreating a common cavity, in the same time with the section of Upper esophageal sphincter [ 25 ].
Long term results of endosurgical and open surgical approach for Zenker diverticulum. Consequently, this operating technique is well standardized for the management of this condition. Diverticule pharyngo- oesophagien de zenker a propos de cinq cas. In other projects Wikimedia Commons. The patients with Zenker diverticulum frequently associate hiatal hernia.
The section of the diverticulum using a linear stapler, followed by one layer of manual suture for safety, simplifies this approach. The indication for surgical treatment was based on the severe dysphagia, which may cause in more than half of the patients, important weight loss. Generally, treatment is the “palliation” of symptoms and improvement in quality of life. The opponents of this technique rise attention about the risk of abandoning a possible malignant lesion inside the pouch, on one side and on the other side, that the resection is not much more complicated than diverticulopexy [ 1617 ].
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Thoracoscopic esophageal diverticulectomy and myotomy. Minimally invasive surgery for Zenker diverticulum: J Thorac Cardiovasc Surg. The specific complication after surgery, esophageal leak, occurred early in 2 women patients.
Nevertheless, long term administration of proton pump inhibitors in patients with or without surgical treatment for Zenker diverticulum, can be justified [ 10 ]. The exact etiology remains unclear; the most accepted theory is that the disease is consequent to a functional disorder of pharyngo-esophageal motility, represented by increased resting pressure of the upper esophageal sphincter, lack of relaxation during swallowing and especially the lack of synchronization between upper esophageal sphincter and hypopharynx during swallowing.
Back in theSchmid communicated the diverticulopexy, with lower morbidity and mortality compared with the resection. R VaillancourtA Duranceau. Laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction for a terminal achalasia. It is a pseudo diverticulum not involving all layers of the esophageal wall. Author information Article notes Copyright and License information Disclaimer. Outline Masquer le plan.
Other methods include fibreoptic diverticular repair. Operating room set up, divertucule of patient and equipment, instruments used are thoroughly described. The patient first undergoes a laparoscopic Heller’s myotomy but does not experience significant improvement in his symptoms. The advantages compared with classic surgery are the absence of scar, diminished postoperative pain, early reestablishing of oral feeding and reduced length of hospital stay [ 24 ].
It has an incidence of 2 perper year in the UK, but there is significant geographical variation around the world. The technical key steps of the surgical procedure are presented in a step by step way: No complications were reported in the postoperative period, and zenked was possible on postoperative day 7.
This has to be done carefully, to the level of mucosa, regardless of the macroscopic divertlcule, often normal, of the muscular layer. With the therapeutic attitude diverticulw from conservative to surgical with associated morbidity and mortalitythe importance of knowing the etiopathology and clinical implications of the disease for establishing the management of the case is mandatory. The trauma of the pharyngeal posterior wall occurs intraoperatively and can pass unnoticed.
Exceptional, pharyngo-esophageal diverticulum can be a rare complication after the surgery of the cervical spine trauma dislocation, fracturethat uses metal plate for fixation. It was named in by German pathologist Friedrich Albert von Zenker.