Objectives To compare 1) long-term symptomatic outcomes and 2) patient satisfaction between open-neck surgery and endoscopic stapling diverticulotomy (ESD) for Zenker's diverticulum. Methods Patients undergoing operation for Zenker's diverticulum during the last 10 years (1998 through 2007) at our institution were telephoned and questioned of dysphagia, coughing and choking, regurgitation, halitosis, weight loss, and recurrent pneumonia based on a validated Gastrointestinal Quality-of-Life Index. Symptom degree pre-operatively, one-month postoperatively, and time of phone call were recorded. Results 39 of 81 patients were contacted. Of these, 14 underwent ESD and 25 had open-neck procedures. Average follow-up time was longer for the open-neck group (4.6 vs. 1.8 years, p<0.01, t-test). Age at operation, diverticulum size, pre-operative symptom scores, and long-term follow-up scores at phone call were not statistically different between the two groups. When patients were asked if symptom relief was complete, improved, unchanged, or worse, a greater proportion of open-neck patients claimed a complete response (67% vs. 43%, p=0.09, contingency analysis) at longer follow-up times. The recurrence of symptoms leading to re-operation was higher for ESD (4 versus 2). Conclusions Long-term symptomatic outcomes between the 2 populations are similar. However, a greater proportion of patients with open-neck procedures claimed complete response. Since the Zenker's location is unchanged in ESD, this may explain persistent symptoms the patient may be experiencing. Greater patient numbers are needed for statistical significance.
Rare giant zenker’s diverticulum with mediastinal extension
