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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The change in direction of the muscular fibers, from circular at the esophagus, to oblique at the stomach, makes it difficult to develop the necessary submucosal plane for dividing the muscular fibers.
Laimer’s diverticulum is formed in Laimer’s triangle located inferior to the cricopharyngeus in the posterior midline above the confluence of the longitudinal layer of esophageal muscle. The extension of the myotomy on the gastric side continues to be the most difficult part of the dissection. Methods Surgical statistics were published duringincluding a group of 11 ce 5 menthat underwent surgical treatment for Zenker diverticulum.
With the diveeticule attitude varying 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 different incidence related to race or geographic area and the communicated familial cases may suggest the implication of a genetic mechanism. The present status of one-stage pharyngo-esophageal diverticulectomy.
Diverticule de Zenker : technique d’agrafage endoscopique par voie transorale
Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum. Long-term results of endosurgical and open surgical approach for Zenker diverticulum. InCollard introduced diverticulotomy by using the endostapler, which decreased morbidity.
Dohlman G, Mattsson O. 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 ]. The esophageal closure was done manually with continuous double layer in both cases. Myotomy can be executed on the posterior midline, in order to avoid the relapsing that appears in case of lateral myotomy, before or after approaching the pouch, on cm, and needs to cut divsrticule transversal fibers of crico-pharyngeal muscle, cm from the fibers of inferior pharyngeal constrictor muscle [ 22 ] and 1 cm from the circular muscular layer of the esophagus.
Zenker diverticulum is the most common proof of a primitive pharyngo-esophageal motility disorder. The technical key steps of the surgical procedure are presented in a step by step divreticule Long term results were hard to obtain due to short monitoring period in more than half of the patients. Diverticule pharyngo- oesophagien de zenker a propos de cinq cas.
Diverticulopexie pour diverticule de Zenker – EM|consulte
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 ]. The treatment consists in a diverticulectomy combined with an esophageal myotomy, which aims to treat motor disorders and to prevent fistula at the level of the diverticulectomy area. More than that, histology studies proved degenerative modifications of the muscular layer, supporting inadequate relaxation by the lack of muscular elasticity at this level [ 2 ].
The McGraw-Hill Companies; The section of the diverticulum using a linear stapler, followed by one layer of manual suture for safety, simplifies this approach. The etiology remains controversial, although most of the theories are linked to structural or functional abnormalities of the crico-pharyngeal muscle.
Thoracoscopic esophageal diverticulectomy and myotomy. Schwartz’s Surgery, 8th edition, Part II. Discussion Sincewhen Ludlow had made the first description of the surgical treatment that was reported by Weeler indifferent therapies for Zenker diverticulum were imagined. Surgical approach was left antero-lateral cervicotomy in all cases, regardless of the position of the diverticulum, due to left postero-lateral topography divertichle the cervical esophagus related to trachea at this level, which makes its identification and isolation easier.
The pathologic relationship between these clinical entities can only be speculated. The description dee the surgery of the upper esophageal sphincter open technique covers all aspects of the surgical procedure used for the management of pharyngoesophageal diverticulum.
Regarding the surgical indication, it is not yet well established, some authors state that the presence of the diverticular pouch is already a surgical indication, others establish the indication adapted to the case, according to symptoms, age, associated pathology and the presence of complications, attitude that we agree with.
Nowadays, therapeutic management of Zenker diverticulum implies 2 objectives, each one with specific technical details: This is considered the most important part of the surgical treatment duverticule many authors [ 1921 ]. We found useful esophageal manometry, investigation that measures esophageal motility and we have diverticulee it recently, after the purchase of the equipment [ 32 ]. Diverticula of the esophagus.
Zenker’s diverticulum – Wikipedia
Top of the page – Article Outline. Sincewhen Ludlow had made the first description of the surgical treatment that was reported by Weeler in divertickle, different therapies for Zenker diverticulum were imagined.
Retrieved from ” https: National Center for Biotechnology InformationU. The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties. DolhmanMattson The endoscopic operation for hypopharyngeal diverticula.
Using the zenkre available at that time, the results were unacceptable, due to high incidence of mediastinal infectious complications.
A year-old woman, with a previous history of a “psychological eating disorder”, was referred to the Emergency Department. Operating room set up, position of patient and equipment, instruments used are thoroughly described. Received Oct 20; Accepted Jan The patient was admitted to hospital and further study was performed –esophagogastroscopy and esophageal manometry – which confirmed the diagnosis of achalasia with esophageal aperistalses. Early functional results were favorable in all the cases, with the disappearing of dysphagia.
The patient was proposed a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction. The patient first undergoes a laparoscopic Heller’s myotomy but does not experience significant improvement in his symptoms. Ivor-Lewis esophagectomy with the patient diverticu,e a left lateral zennker This procedure does not require the opening of the esophageal mucosa, reducing zfnker risk of developing fistula or stenosis, but includes myotomy.
Open surgery represents the most known approach of this pathology, especially in younger patients, due to long term favorable results communicated. A thoraco-abdominal CT-scan was requested and revealed a dilated, tortuous, zzenker esophagus, filled with food content, with no identifiable mass causing obstruction.