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Ann Thorac Surg 1998;66:347-350
© 1998 The Society of Thoracic Surgeons

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Original articles: general thoracic

Zenker’s diverticulum in the elderly: is operation justified?

^a Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Address reprint requests to Dr Trastek, Mayo Clinic, 200 First St SW, Rochester, MN 55905

Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.

Background. Surgical correction of symptomatic Zenker’s diverticulum is effective; however, elderly symptomatic patients may be denied surgical intervention because of perceived increased risks.

Methods. To address this concern, we reviewed 75 patients (46 men and 29 women) found to have this condition during the past two decades.

Results. Median age was 79 years (range, 75 to 91 years). Preoperative symptoms included dysphagia in 69 patients (92%), regurgitation in 61 (81%), pneumonia in 9 (12%), halitosis in 3 (4%), and weight loss in 1 (1%). Gastroesophageal reflux symptoms were noted in 27 patients (36%). Diagnosis was made by barium swallow in 63 patients, esophagoscopy in 5, and a combination of both in 7. Surgical procedures included both diverticulectomy and myotomy in 57 patients (76%), myotomy alone in 9 (12%), diverticulopexy and myotomy in 5 (7%), and diverticulectomy alone in 4 (5%). There was no in-hospital mortality. Complications occurred in 8 patients (11%) and included esophagocutaneous fistula in 4, pneumonia and urinary tract infection in 1, and wound infection, myocardial infarction, and persistent diverticulum in 1 each. Follow-up was available in 72 patients (96%) and ranged from 8 days to 17 years (median, 3.3 years). At follow-up, 64 patients (88%) were asymptomatic and 4 (6%) were improved with minimal symptoms. The remaining 4 patients (6%) have had varying degrees of dysphagia and all have been treated with periodic esophageal dilations.

Conclusions. Operation for symptomatic Zenker’s diverticulum in the elderly is safe and effective and will result in resolution of symptoms and improved quality of life in most patients

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