THE RESULTS OF TREATMENT OF ZENKER'S DIVERTICULUM BY SURGICAL AND ENDOSCOPIC METHOD
Modern problems of science and education. Surgery
Aims. To carry out a comparative assessment of surgical and endoscopic treatment options for Zenker's diverticulum. Materials and methods. The work presents the data on treatment of 170 patients with Zenker's diverticulum. Surgical resection of diverticulum was done in 58 (34%) patients, and endoscopic diverticulo-esophagostomyin 103 (61%) patients. Dysport was administered [m. cricopharyngeus] in 9 (5%) patients. Results. It is demonstrated that endoscopic techniques have minimal traumatism of
... the operation and have almost no complications in the postoperative period, and in all cases relieve the patient from dysphagia syndrome. By 12 months of follow-up only 13 patients required repeated endoscopic diverticulo-esophagostomy. The analysis of the cause of dysphagia resumption suggested that the cause is incomplete dissection of the diverticulum anterior wall in the group of patients with medium or large diverticular cavity. The result obtained was evaluated over the long-term based on the clinical picture, instrumental methods of examination, and study of the quality of life of patients using the validated version of the international questionnaire Medical Outcomes Study-Short Form (SF-36). In all cases, a good clinical outcome and improved quality of life was obtained on all scales of the SF-36 questionnaire after the performed treatments. Conclusions. Surgical and endoscopic treatment of Zenker's diverticulum determine a good outcome, but endoscopic treatment provides a more rapid rehabilitation of patients, relieving them from cosmetic skin defects. Keywords: Zenker's diverticulum, endoscopic diverticulo-esophagostomy, surgical resection of the diverticulum, quality of life. INTRODUCTION. A pharyngoesophageal diverticulum (Zenker's diverticulum) typically appears in the pharyngoesophageal junction through Killian's dehiscence in the space between the Killian bundle and cricopharyngeal muscle. It was first described in 1877 by Zenker and was later named after this scientist. In the described triangle, the pharyngoesophageal wall is built up from weakly expressed inferior pharyngeal constrictor muscle and the transversal fibers of the cricopharyngeal muscle, which promotes the development of its sac-like outpouching with further formation of a diverticulum. The transverse bundle of m. cricopharyngeus acts as a sphincter and forms the first cricopharyngeal narrowing of the esophagus. The anatomical weakness of the posterior pharyngeal wall in Killian's dehiscence cannot be a single promoting factor for the development of Zenker's diverticulum (ZD). Other predisposing factors include increased pressure in the hypopharyngeal space, reduction of cells in plexus myentericus, often consecutive swallowing movements for the effective cleaning of the oral cavity, and discoordination of the oral and pharyngeal phase of swallowing in elderly people  . ZD develops primarily in elderly people. It is a relatively rare disease, which is observed in 1.5-5% of all the esophageal diverticulum types. In Russia, the morbidity rate of ZD is 3 cases per 100,000 people. Men suffer from ZD 2-3 times more often than women .