ABCD: Arquivos Brasileiros de Cirurgia Digestiva (Sep 2008)

Tratamento cirúrgico do divertículo de Zenker Surgical treatment of Zenker's diverticulum

  • Guilherme Behrend Silva Ribeiro,
  • Fernando Mielke,
  • Bernardo Silveira Volkweis,
  • Carlos Cauduro Schirmer,
  • Cléber Dario Pinto Kruel,
  • Gustavo Morellato,
  • Marcelo Binato,
  • Richard Ricachenevsky Gurski

DOI
https://doi.org/10.1590/S0102-67202008000300003
Journal volume & issue
Vol. 21, no. 3
pp. 110 – 113

Abstract

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RACIONAL: O tratamento cirúrgico do divertículo de Zenker inclui na maioria dos casos a cricomiotomia do músculo cricofaríngeo, a qual pode ser associada à diverticulopexia ou diverticulectomia. A escolha destas opções cirúrgicas ainda é controversa. OBJETIVO: Avaliar os resultados de dois tratamentos cirúrgicos (diverticulopexia ou diverticulectomia, ambos associados à cricomiotomia) em uma série de casos. MÉTODOS: Estudo retrospectivo em período de 10 anos de 26 pacientes submetidos ao tratamento cirúrgico do divertículo de Zenker. Para análise estatística, os pacientes foram divididos em dois grupos: Grupo 1 - diverticulectomia (n=17) e Grupo 2 - diverticulopexia (n=9). Em todos realizou-se miotomia. Foram avaliadas as variáveis: tempo cirúrgico, de internação e de início da alimentação via oral, complicações gerais, ocorrência de fístulas, recidiva dos sintomas e mortalidade. Consideraram-se diferenças significativas quando PBACKGROUND: Surgical treatment of Zenker's Diverticulum comprise in the majority of cases cricopharyngeal miotomy, which may be associated with diverticulopexy or diverticulectomy. The election of these surgical options remains controversial. AIM: To evaluate the results of two surgical treatments (diverticulopexy or diverticulectomy, both associated with miotomy) in a case series. METHODS: Retrospective study comprising a 10-year period of 26 patients submitted to surgical treatment of Zenker's Diverticulum. For statistical analysis, patients were divided in two groups: Group 1 - diverticulectomy (n=17), and Group 2 - diverticulopexy (n=9). All were submitted also to a cricomiotomy. The following variables were evaluated: operative time, in-hospital stay, time to initiate oral feeding, general complications, fistula occurrence, symptom recurrence and mortality. Significant differences considered when P<0.05. RESULTS: Mean age was 64 years. Main pre-operative symptoms were: dysphagia (91%) and regurgitation (46%). All patients were diagnosed with pre-operative barium esophagram and 58% (n=15) did upper gastrointestinal endoscopy. There wasn't significant difference related to mean operative time (96 x 99 min), in-hospital stay (5,5 x 5 days), time to initiate oral feeding (7,5 x 4 days), occurrence of esophagocutaneous fistula (35 x 22%), dysphagia recurrence (6 x 11%), general post-operative complications (41 x 33%) and follow up period ( 7,5 x 9 months). The mortality was null. CONCLUSION: Surgical treatment of Zenker's Diverticulum is a relatively safe therapeutic method, with acceptable morbidity and the results are comparable between diverticulopexy and diverticulectomy.

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