The surgical treatment of Zenker diverticulum relieves dysphagia, coughing, and aspiration in nearly all patients. An understanding of the physiological basis for circopharyngeal myotomy and anatomical detail has contributed to the high success rate. Meticulous technique in this elderly patient group is essential to prevent complications.
Incision for operation. The investing layer of the deep cervical fascia is incised to expose the medial border of sternomastoid muscle. A cervical cutaneous nerve in the upper extent of the incision is avoided.
The inferior belly of the omohyoid muscle is exposed, clamped, cut, and ligated. The middle thyroid vein and inferior thyroid artery are divided and ligated.
The diverticulum is dissected from the overlying fascia. The recurrent laryngeal nerve has been identified.
The neck of the diverticulum is carefully dissected until it is freed from the muscle. A cricopharyngeal myotomy is performed, starting at the neck.
The myotomy is extended distally 4 to 5 cm.
Suspension of the diverticulum to the prevertebral fascia with nonabsorbable monofilament sutures.
Large diverticula should be stapled and excised.
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