diverticulotomy

Diverticulotomy is a surgical procedure used to treat diverticula that communicate with a hollow organ by dividing the wall that separates the diverticulum from the lumen, thereby creating a single cavity and relieving obstructive symptoms. It is most commonly performed for Zenker's diverticulum, a posterior pharyngoesophageal pouch that can cause dysphagia, regurgitation, coughing, aspiration, and weight loss.

Indications typically include symptomatic Zenker's diverticulum or diverticula large enough to impair swallowing or airway protection, especially when conservative measures have failed. The goal is to improve esophageal emptying and reduce outflow resistance at the cricopharyngeal region. Preoperative evaluation usually involves a barium swallow study and endoscopic assessment to delineate anatomy and plan the approach.

Techniques fall into open/transcervical and endoscopic categories. Open diverticulotomy may be performed with or without diverticulectomy and is commonly accompanied by cricopharyngeal (upper esophageal sphincter) myotomy to address the underlying dysfunction. Endoscopic diverticulotomy divides the common wall between the diverticulum and the esophageal lumen using a stapler, laser, or electrocautery (septotomy); this can be done with or without a concurrent myotomy. Endoscopic methods tend to have shorter recovery times but may have a higher risk of certain complications in some anatomies.

Postoperative care includes staying NPO (nothing by mouth) for a period, followed by gradual progression of diet with swallow evaluations as indicated. Potential complications include perforation with mediastinitis, bleeding, infection, fistula formation, stricture, and recurrence of diverticulum symptoms. Overall, diverticulotomy provides relief for many patients with Zenker's diverticulum, with outcomes influenced by patient factors and the chosen surgical technique.