Endoscopic vs Open‐Neck Zenker Diverticulum Surgery

Objective Compare long‐term symptomatic outcomes between open‐neck surgery and endoscopic stapling diverticulotomy (ESD) for Zenker diverticulum. Method Patients at least 1 year after surgery for Zenker diverticulum were telephoned and questioned of dysphagia, choking, regurgitation, and halitosis based on a validated Gastrointestinal Quality‐of‐Life Index. Symptom degree preoperatively and at phone call was assessed. Patients rated their overall postoperative symptoms as worsened, unchanged, improved, or completely resolved. Results A total of 55 of 102 patients were contacted. Of these, 24 underwent ESD and 31 had open‐neck procedures. Average follow‐up time was longer for the open‐neck group (5.7 vs 3.1 years, P <. 01). Gender, age at operation, diverticulum size, and preoperative symptom scores were not statistically different between the 2 groups. For both techniques, symptom scores showed significant improvement postoperatively ( P <. 01). A greater proportion of patients undergoing open‐neck procedures reported their symptoms to be completely resolved or improved (93% vs 67%, P =. 015). Specifically, complete resolution of symptoms was achieved more often in those who had open‐neck surgery (77% vs 50%, P =. 047). Conclusion Both the open neck and ESD surgeries significantly benefit patients, regardless of diverticulum size. Long‐term symptomatic outcomes between the 2 populations indicate that patients with open‐neck procedures attain a greater degree of resolution of preoperative symptoms. This may be due to fundamental differences between the surgical techniques.