In a series of 217 patients with Zenker's (hypopharyngeal) diverticulum, there were 146 males and 71 females ranging in age from 34 to 91 years of age with the largest number in the 60 to 70 year age group. The most serious associated findings were esophageal obstruction, foreign bodies, loss of weight and the bronchopulmonary pathology of aspiration, such as pneumonia and lung abscess due to overflow. The diagnosis was readily established by the esophagram. However, failure to demonstrate the sac, prior to attempted foreign body removal or leakage from incomplete diverticulectomy elsewhere, had resulted in the severe complications of mediastinitis and esophagocutaneous or esophagopleural fistula in six patients, one of whom died. They were first seen for management of mediastinitis, and the diverticula were demonstrated on subsequent study. Seventeen had other esophageal pathology in addition to the Zenker's diverticulum. It is accepted that management of a Zenker's diverticulum is surgical; yet, of the 217 patients, surgery was contraindicated in 11 for medical reasons or they died of their disease before surgery could be attempted. Twenty-eight procrastinated and postponed or refused treatment. Twenty-one had had one to three operations previously for their diverticula. A variety of surgical procedures were used; in 18 patients the only operative procedure was esophagoscopy for various reasons: seven because postoperative stenosis or atresia of the cervical esophagus, following diverticulectomy elsewhere, required only esophagoscopy, and 11 refused further surgery for the diverticula, six of whom had had foreign bodies lodged in the sac. Complications in association with this condition were numerous. Three of the 108 diverticulectomies died following surgery, one 68, one 78 and one 84 years of age. Two of the diverticulotomies developed mediastinitis, one following vomiting the evening of the operative day, and one in whom the cautery admittedly extended too deeply. Both recovered and later had diverticulectomies. Left recurrent laryngeal nerve paralysis occurred in six patients, three temporary and three permanent. Postoperative stenoses were seen in four (in addition to the seven operated elsewhere). The four of our own cases required one to three dilatations of the cervical esophagus. Twenty-one patients, or 10 percent of the series, had had one or more previous operations for their Zenker's diverticulum, and 19 of our own patients developed symptoms of recurrence in up to 26 years. Recurrence rate was highest following diverticulotomy, but the sac remained small, did not cause obstructive symptoms and emptied readily without overflow into the larynx. For these reasons we now reserve the diverticulatomy for the older, severely debilitated patients and the more definitive diverticulectomy for younger patients. © 1969, SAGE Publications. All rights reserved.
