A Comparative Study of Outcomes for Endoscopic Diverticulotomy versus External Diverticulectomy

Objectives Current literature on the treatment of Zenker’s diverticulum (ZD) favors the use of various endoscopic procedures over external surgical techniques for patients, arguing that endoscopic approaches reduce intraoperative time and anesthesia, length of hospital stay, and days until oral diet is restarted. However, such techniques often have higher symptomatic recurrence rates and require further interventions. Because of our experience with both endoscopic diverticulotomy (ENDO) and external diverticulectomy (EXT) using the GIA-stapler, we sought to compare these 2 procedures in terms of in-hospital parameters, complications, return to normal diet, and rates of symptom recurrence. Study Design Case series with chart review. Setting Academic tertiary care hospital. Subjects Patients with Zenker’s diverticulum who underwent surgical repair. Methods Retrospective analysis of 67 patients seen at Brigham and Women’s Hospital between 1990 and 2012 with Zenker’s diverticulum who underwent either an endoscopic Zenker’s procedure (36) or an external stapler-assisted diverticulectomy with cricopharyngeal myotomy (31). Results Although the external stapler-assisted procedure for ZD does carry a longer intraoperative time and a slightly longer hospital stay than the endoscopic approach, it provides similar days until initiation of an oral diet and a similar incidence of postoperative complications. Further, it is superior to the endoscopic approach when one considers its much lower rate of symptomatic recurrence and need for revision procedures. Conclusion We argue that the external stapler-assisted diverticulectomy with cricopharyngeal myotomy should be considered as a viable treatment in patients who need definitive, single-session treatment for ZD, especially to prevent life-threatening aspiration pneumonia.