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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This may be performed through a diverticuloscope. It has an incidence of 2 perper year in the UK, but there is significant geographical variation around the world.
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This process demonstrated at immuno-histochemistryalso affects the muscularis propria zfnker of the cervical esophagus [ 56 ]. This video demonstrates a patient with epiphrenic esophageal diverticulum.
Exceptional, pharyngo-esophageal diverticulum can be a rare complication after the surgery of the cervical spine trauma dislocation, fracturethat uses metal plate for fixation. A year-old woman, with a previous history of a “psychological eating disorder”, was referred to the Emergency Department.
Diverticulopexie pour diverticule de Zenker – EM|consulte
Barium passage shows the diverticular pouch, giving details about size, localization, retention of contrast, position related to esophageal wall and esophageal motility.
Surgical indication must be carefully established, after thorough evaluation. We have resected the diverticular pouch, an attitude that we consider good for improving dysphagia and preventing stasis complications and dvierticule transformation. World J Gastrointest Surg. The section of the diverticulum using a linear stapler, followed by one layer of manual suture for safety, simplifies this approach.
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 the 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.
Principles of surgical treatment of Zenker diverticulum
Once the myotomy is completed a standard Dor Fundoplication is performed. This should be done as high as possible, for evacuation. Both objectives can be achieved by classic or minimal invasive through endoscopy. The diagnosis is suspected based on clinical symptoms and easily confirmed by imaging studies available almost everywhere barium passage divertichle upper endoscopy.
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The extension of the myotomy on the gastric side continues to be the most difficult part of the dissection. If the surgical intervention is well done, the incidence of salivary fistula, specific complication of this operation, is minimal [ 19 ].
Minimally invazive surgery for Zenker diverticulum: Discussion Sincewhen Ludlow had made the first description of the surgical treatment that was reported by Weeler indifferent therapies for Zenker diverticulum were imagined.
The surgeon starts by dissecting the gastroesophageal junction. The technical key steps of the surgical procedure are presented in a step by step way: A retrospective review of pharyngeal pouch surgery in 56 patients.
Long term results of endosurgical and open surgical approach for Zenker diverticulum. CO2 laser versus endoscopic stapling”. 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 ]. From Wikipedia, the free encyclopedia.
B DallemagneS Perretta. This procedure does not require the opening of the esophageal mucosa, reducing the risk of developing fistula or stenosis, but includes myotomy.
The trauma of the pharyngeal posterior wall occurs intraoperatively and can pass unnoticed. Access to the PDF text.
Open in a separate window. The simple myotomy as therapy, exposes the patient to specific risks given by the presence of diverticular pouch, including malignant transformation.
Other non-surgical treatment modalities also exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.
The simple approach of the dievrticule 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.