[Plea in favour of external cervicotomy approach of Zenker's diverticulum: 73 cases reported]. / Plaidoyer pour un abord externe par cervicotomie du diverticule de Zenker: à propos de 73 cas.

INTRODUCTION: Zenker's diverticulum can be treated surgically or endoscopically. The aim of this study was to assess results of surgical approach with cervicotomy and diverticulectomy. PATIENTS AND METHODS: We retrospectively studied the data of 73 patients (50 men and 23 women; mean age, 69 ans; extrêmes: 43-98) consecutively operated on for a Zenker's diverticulum between 1987 and 2000. Surgical procedure included diverticulectomy associated with a large myotomy and oesophageal calibration. Both early and long-term results were compared with those of published series of patients treated by stapled esophagodiverticulostomy. RESULTS: Clinical manifestations were: dysphagia (97%), regurgitations (76%), aspirations (45%), weight loss (28%), lung infection (21%), or halitosis (3%). No patient died postoperatively. The early morbidity rate was 4% (3 patients). The mean delay for return of oral feeding and the mean length of hospital stay were respectively 6 and 8 days. At follow-up (mean follow-up, 6 years; extremes: 3 months-13 years), 72 patients (99%) were satisfied and 1 patient felt partially improved. Analysis of published results of series of endoscopic treatment revealed shorter lengths of hospital stay but less favourable long-term results. CONCLUSIONS: Early morbidity of surgical treatment of Zenker's diverticulum is low. Long term functional results could be better after surgical diverticulectomy with myotomy than after endoscopic stapled esophagodiverticulostomy.

[Uvular edema. Diagnostic, etiologic and therapeutic management]. / Oedème uvulaire. Prise en charge diagnostique, étiologique et thérapeutique.

Acute oedema of the uvula is relatively rare, and often idiopathic. None the less, possible causes should be excluded, such as allergy, infection, trauma or mechanical. Hereditary angioneurotic oedema should be excluded when there are identical recurrent episodes. Although three of our patients had a recent herpetic viral infection, it does not seem likely that this was the cause. Treatment consists mainly or antihistamines, steroids, antibiotics, or specific treatment for hereditary angioneurotic oedema. The clinician must always bear in mind the potential seriousness or this condition as a cause of obstruction of the upper airway. In the light of four recent cases, the authors discuss the diagnosis, cause and treatment of this particular condition.