Análise comparativa das ténicas de diverticulopexia e de diverticulectomia no tratamento do divertículo de Zenker: Uma revisão de literatura / Comparative analysis of diverticulopexy and diverticulectomy techniques in the treatment of Zenker's diverticulum: A literature review

Zenker's diverticulum (DZ), the most common among pseudodiverticulum, originates from an area of fragility located in the posterior pharynx, between the lower constrictor muscle and the cricopharyngeal muscle1,2. DZ mainly affects the elderly population and has great clinical importance due to its malignant potential and risk of infection2. Surgical treatment includes two main approaches: diverticulectomy (diverticulum resection), and diverticulopexy, which consists of surgical fixation of the diverticular structure1,2. Objective: To compare the results of diverticulectomy and diverticulopexy in the treatment of DZ. Methods: A search was made in the Scielo, PubMed and BMJ databases, using the descriptors "Zenker's diverticulum", "Surgical procedures", "Therapeutic" and "Diverticulum". Articles from clinical trials published between 1997 and 2020 in Portuguese, English, French and Spanish were included, performing a critical review of the literature comparing both surgical techniques cited. Discussion: The surgical indication for DZ is based on the presence of dysphagia, regurgitation, weight loss, and diagnostic confirmation by imaging methods, the most common being esophagography with barium3. Our results show that from the analysis of clinical trials that compared the two surgical techniques as definitive treatment, it is observed that both have low mortality rate, besides similar functional preservation of the sphincter4,5. Among the studies, one points out diverticulectomy as more efficient in relieving dysphagia6. The latter, although more invasive, is recommended in young patients with larger diverticula, since it minimizes the risk of malignancy7,8. On the other hand, diverticulopexy is indicated for elderly patients with minor lesions and has the advantage of early food reintroduction and reduced hospitalization time7,8. There is also, in the latter, lower risk of fistulas and other postoperative complications3. Finally, studies report the importance of performing concomitant cricomyotomy to avoid recurrence, regardless of the surgical technique employed7. Final considerations: The studies analyzed showed convergence regarding low morbidity and esophago-pharyngeal functional preservation4,6,8. In conclusion, the choice of technique should be based on the staging of the condition and the individuality of the patient2.