Hypopharyngeal Pouch, also known as Zenker's Diverticulum, is best described as an abnormal ballooning of the back wall of the throat (hypopharynx). The exact pathology is not clearly understood but is a combination of a number of factors including abnormal relaxation of the muscle at the top of the oesophagus (the cricopharyngeus) and a weakness in the back wall of the hypopharynx. The reflux of stomach contents up the oesophagus may also play a role.
With small pouches, no surgical treatment may be necessary. Antacids and antireflux measures may be all that is required. In the case where there is a small pouch present accompanied by difficulty with swallowing because of the abnormal relaxation of the cricopharyngeus muscle, division of the cricopharyngeus muscle may be all that is required. This is undertaken under general anaesthetic through a left neck incision. With larger pouches, both the cricopharyngeus muscle and the pouch need to be addressed. There are two basic approaches for this.
The more standard method is through a left neck incision and the pouch is then identified at the back of the throat/oesophagus. This is undertaken after the top of the pouch has been identified using a scope passed down through the mouth. The cricopharyngeus muscle is carefully divided through the left neck incision so as not to perforate the oesophagus. The problem of the pouch is then addressed by a number of methods. The pouch can be inverted, suspended or resected
The second method uses the endoscopic stapling technique. In some patients it may not be possible to undertake this method because the shape of the mouth or throat prevents the passing of a scope to identify the top of the oesophagus. If the pouch can be identified, a stapling device is applied to the common wall between the oesophagus in the front and the pouch behind. The stapler staples rows of sutures and divides the wall thereafter. Thereby, the cricopharyngeus muscle in the common wall is divided and the pouch and oesophagus become a common cavity.
In the vast majority of cases, there is an overnight hospital stay and following a brief checkup in the morning, a soft diet is commenced. Discharge then takes place a day following surgery.
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