New methodology endoscopic treatment of diverticule of the Zenker

Abstract

Background: To evaluate the effectiveness of endoscopic cryo-pharingo-esophago-myotomy using a combination technique in the treatment of patients with Zenker's diverticulum. Methods and materials: The initial incision of the mucous membrane and the subsequent dissection of the muscles takes place in the middle of the cricopharyngeal fold. After the complete intersection of the cricopharyngeal muscle, the actual tunneling stage of the operation is performed, the purpose of which is to perform an upper esophageal myotomy. After performing the myotomy of the required length, the apparatus is removed from the tunnel and the mucous membrane is subsequently dissected. First, the mucosa from the diverticulum to its bottom is cut in the longitudinal direction. The second stage on the same length dissects the mucosa of the esophagus. You should strive to dissect the mucous strictly in one direction without bias. Subsequently, this is the key to successful application of clips and hermetic information of the mucous membranes. In the period from June to November 2018 in the MKNC A.S. Loginov on the Zenker's diverticulum 18 surgical interventions were performed using a new combined technique. The average age of patients was 62 (from 35 to 80 years). The time of surgical intervention averaged 40 minutes. Results: The peculiarity of the patients who underwent surgery using the new combined method was the almost complete absence of the residual cavity of the diverticulum during the X-ray control examination. Conclusions: Combined endoscopic surgery for Zenker's diverticulum allows to successfully expand the scope of surgical intervention by performing an extended myotomy and dissection of the mucous membrane of the septum. This allows you to create conditions for the prevention of recurrence of the disease, thereby providing the best result of treatment.