This protocol addresses symptomatic Zenker's diverticulum, or a Zenker's (hypopharyngeal) diverticulum larger than 1 cm, in patients who have already undergone an endoscopic approach without adequate symptom relief. Treatment decisions in this setting are influenced by local expertise and the anatomical feasibility of procedures.
Initial management with endoscopic treatment — rigid endoscopic stapling, flexible endoscopic septotomy, Zenker's peroral endoscopic myotomy (Z-POEM), or endoscopic dilation — did not achieve relief of symptoms such as dysphagia and regurgitation. This protocol represents the next step after that failure.
The next step involves an open surgical approach via a neck incision to expose the diverticulum, with attention to the underlying outflow obstruction. Several operative options exist depending on diverticulum size and location. The full structured protocol — including procedure selection — is available via the link below.
Resolution of Zenker's diverticulum symptoms, including dysphagia and regurgitation.
For patients with symptomatic ZD or diverticula larger than 1 cm, treatment decisions depend on local expertise and the technical feasibility of procedures, which are influenced by the patient's anatomy.
Open surgical approaches, such as diverticulectomy with cricopharyngeal myotomy, have historically been the standard for the management of ZD.
The procedure involves making a neck incision to expose the diverticulum followed by myotomy of the CP muscle to relieve outflow obstruction.
The diverticulum may be managed by excision (diverticulectomy), suspension (diverticulopexy), or inversion, depending on its size and location.
When performed correctly, this approach achieves symptom resolution in 90–95% of cases with low recurrence rates.
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