- One stage cricopharyngeal myotomy and diverticulectomy has been the preferred approach in patients who are good surgical candidates
- Can be performed with a rigid endoscope or with an open cervical approach.
- Stapled
- Rigid endoscopes with specialised staplers can be used to divide the muscular bar and tissue between the Zenker’s and the oesophagus.
- NB: Need good neck extension (which some elderly don’t have!)
- Open
- In the open approach, the patient is positioned with the head and neck facing away from the affected side (most commonly left) and an incision is over the anterior border of SCM.
- The EJV may be ligated, the plane anterior to SCM developed with lateral retraction of the carotid sheath.
- The space between the carotid sheath laterally and the tracheo-oesophageal column medially is crossed by 3 structures;
- Omohyoid (transect or retract),
- Middle thyroid vein (ligate)
- Inferior thyroid artery (lower than the space needed)
- The diverticulum is then dissected free of surrounding tissue, opened, a finger inserted into the oesophagus, and the horizontal fibres of cricopharyngeus divided under vision.
- The diverticulum is then stapled off.
- The wound is closed in layers over a closed-suction drain.