Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events. Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy. Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes, P = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days, P < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02, P = 0.017), smoking (OR = 2.10, P = 0.044), and operation time (OR = 1.01; P = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( P = 0.020), higher length of hospitalization ( P < 0.001), and higher mortality ( P = 0.027) and readmission rates ( P = 0.023). Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients. Level of Evidence: NA

The Esophageal Diverticulum: About Two Cases

The hypopharyngeal diverticulum of the cervical esophagus, also knows as Zenker's diverticulum, is the most common esophageal diverticulum. It develops at the junction of the hypopharynx and the esophagus. The most present symptom is dysphagia. Between the period of 01/01/2018 to 31/12/2018, we accessed two patients with esophageal diverticulum.both underwent surgical treatment - diverticulectomy at department of the visceral surgery II of the Military Hospital Mohamed V of Rabat.Morocco. The aim of this report is to evaluate the diagnostic methods and the surgical outcomes by comparing them to others technics used in the treatment of the esophageal diverticulum.

Exteriorized Giant Zenker’s Diverticulum: Case Report

Zenker’s diverticulum (ZD) also known as cricopharyngeal (CP), pharyngoesophageal or hypopharyngeal diverticulum is an outpouching of mucosal and submucosal layers originated from the pharyngoesophageal junction. Radiological evaluation of deglutition, modified barium swallow radiography may reveal the retentive character of the diverticular sac and confirm the diagnosis. Many different types of surgical approaches have been developed over the decades with modifications focusing on the need to reduce intra-operative or post-operative complications and overall morbidity. The authors present the case of a 76-years-old woman with spontaneous apparition of an exteriorised tumor in the oral cavity after an excessive cough effort. Surgical treatment is elective, preventing the occurence of complications that may endanger the patients life and improve the quality of life. Surgical therapy was open neck resection of the Zenker’s diverticulum with esophageal myotomy and pharynx reconstruction.

Hypopharyngeal Diverticulum Formation following Anterior Discectomy and Fusion: Case Series

Pharyngoesophageal diverticulum is a rare complication following anterior cervical discectomy and fusion (ACDF). Dysphagia is a well-documented complication associated with ACDF. It may result postoperatively from a variety of etiologies, including hardware displacement, pharyngeal edema, or vocal fold paresis. One rare cause of persistent dysphagia is the formation of a hypopharyngeal diverticulum, reported in the literature in 9 previous cases. Such diverticula after ACDF surgery may have pathogenesis that is distinct from that of typical Zenker diverticula. We report 3 new cases of hypopharyngeal diverticula in patients who underwent revision ACDFs. Variables assessed included age, sex, level of fusion, ACDF-related complications, and diverticulum management. Two patients underwent successful open surgical diverticulectomy and cricopharyngeal myotomy. In the third case, the patient had a small diverticulum close to the surgical hardware and minimal symptoms and was managed conservatively. Our cases, combined with the 9 previous cases, demonstrate commonalities, particularly with regard to the risk of revision spinal surgery and infection and subsequent hypopharyngeal diverticula development. Hypopharyngeal diverticulum can occur as a complication of ACDF and should be considered in patients with persistent dysphagia after surgery. In this patient population, open resection and cricopharyngeal myotomy are recommended.