Currently, the most common treatments for a Zenker's diverticulum include conservative management, open surgical diverticulectomy (OSD) with CP myotomy
, and stapler-assisted endoscopic diverticulectomy (SAED) with CP myotomy
that was first reported by Collard et al.
The gold standard treatment is myotomy
; other therapeutic options include balloon dilatation or botulinum toxin injection.
Surgical management is based on disrupting LES by myotomy
. The technique was initially described in 1913 by Ernst Heller (4).
Caption: Figure 2: HRIM manifestation of one achalasia patient before and after peroral endoscopic myotomy
(POEM) operation and one hiatal hernia patient.
Woo, "Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy
: an alternative minimally invasive approach," Laryngoscope, vol.
Open surgery was done in the form of diverticulectomy and cricopharyngeal muscle myotomy
through a lateral cervical approach.
Michaelis  had good results with iliopsoas and obliquus externus myotomy
; Graham et al.
Crural fibers and vagus nerve were identified before commencement of myotomy
Robotically assisted Heller myotomy
is emerging as a safe alternative to the laparoscopic approach.
With the ability to advance the boundaries of minimally invasive surgery and laparo-endoscopic single site surgery in procedures such as Choleystectomy (gallbladder removal), Hysterectomy (removal of uterus), Nephrectomy (kidney resection), Heller Myotomy
(procedure for Achalasia) and more, the laparoscope features:
The laparoscopic Heller myotomy
involves cutting the LES muscle, making it incompetent and allowing food boluses to pass through the LES.
A reduction in LOS pressure can be achieved by disrupting the LOS muscle fibres by generating a radial force from within the oesophageal lumen (by pneumatic dilation), by cutting the muscle fibres (as in myotomy
) or by poisoning them with botulinum toxin (BTox).