Tratamiento del divertículo de Zenker: comparación de diferentes técnicas / Treatment of Zenker’s diverticulum: Comparison of different techniques

Introducción y objetivos: Los divertículos de Zenker se han abordado quirúrgicamente con diferentes técnicas a lo largo de los últimos años, evolucionando desde la vía abierta hasta la endoscópica. En la cirugía endoscópica, se puede utilizar el láser CO2 o la grapadora. Se analizó la recidiva o persistencia del divertículo tras el tipo de cirugía realizado. Método: Es un estudio descriptivo retrospectivo de 22 pacientes tratados de divertículo de Zenker en el servicio de otorrinolaringología de nuestro hospital entre los años 2001 y 2011. Resultados: Se realizó tratamiento con cirugía endoscópica mediante láser CO2 en 13 pacientes, mediante grapadora en 6 pacientes, y en 3 pacientes se realizó abordaje abierto. El tiempo operatorio, de ingesta oral y de ingreso fueron menores en la cirugía con grapadora (52 min, 3 días, 5 días), que en la técnica con láser (58 min, 5 días, 8 días) y mayores en el abordaje abierto (107 min, 8 días, 11 días). El 68% de nuestros pacientes mejoró con la primera intervención, porcentaje que ascendió al 95%, teniendo en cuenta la segunda intervención en los pacientes que recidivaron tras la primera cirugía. Las complicaciones aparecieron en el 13,6% de los pacientes. Conclusiones: El tratamiento de elección en la actualidad del divertículo de Zenker es la cirugía por vía endoscópica. El abordaje endoscópico con grapadora parece presentar menos morbilidad y un tiempo de hospitalización más corto en comparación con el láser CO2 (AU)

Introduction and objectives: Zenker's diverticulum has been approached surgically with different techniques over the years, evolving from open to endoscopic surgery. The CO2 laser or the stapler can be used in endoscopic surgery. Our objective was to ascertain the recurrence or persistence of the diverticulum based on the type of surgery performed. Method: A retrospective descriptive study of 22 patients treated for Zenker's diverticulum in our hospital service between 2001 and 2011. Results: Endoscopic surgery using laser CO2 was performed in 13 patients, using stapler in 6 patients and with open approach in 3 patients. Surgery time, oral intake and hospital stay were greater in the open approach (107 minutes, 8 days and 11 days respectively) and less in surgery with stapler (52 minutes, 3 days and 5 days) than the technique with laser (58 minutes, 5 days and 8 days). With the first intervention, 68% of our patients improved, a percentage that increased to 95% taking into account the second intervention in patients that relapsed after the first surgery. Complications appeared in 13.6% of the patients. Conclusions: The treatment of choice nowadays for Zenker's diverticulum is endoscopic surgery. The endoscopic approach with stapler seems to present lower morbidity and a shorter hospital stay in comparison with the CO2 laser (AU)

[Treatment of Zenker's diverticulum: comparison of different techniques]. / Tratamiento del divertículo de Zenker: comparación de diferentes técnicas.

INTRODUCTION AND OBJECTIVES: Zenker's diverticulum has been approached surgically with different techniques over the years, evolving from open to endoscopic surgery. The CO(2) laser or the stapler can be used in endoscopic surgery. Our objective was to ascertain the recurrence or persistence of the diverticulum based on the type of surgery performed. METHOD: A retrospective descriptive study of 22 patients treated for Zenker's diverticulum in our hospital service between 2001 and 2011. RESULTS: Endoscopic surgery using laser CO(2) was performed in 13 patients, using stapler in 6 patients and with open approach in 3 patients. Surgery time, oral intake and hospital stay were greater in the open approach (107 minutes, 8 days and 11 days respectively) and less in surgery with stapler (52 minutes, 3 days and 5 days) than the technique with laser (58 minutes, 5 days and 8 days). With the first intervention, 68% of our patients improved, a percentage that increased to 95% taking into account the second intervention in patients that relapsed after the first surgery. Complications appeared in 13.6% of the patients. CONCLUSIONS: The treatment of choice nowadays for Zenker's diverticulum is endoscopic surgery. The endoscopic approach with stapler seems to present lower morbidity and a shorter hospital stay in comparison with the CO(2) laser.