Nowadays endoscopic diverticulotomy is the surgical approach of the first choice in treatment of Zenker's diverticulum. We report our experience with this procedure and try to sum up recent recommendations for management of surgery and postoperative care. Data of 34 patients with Zenker's diverticulum, treated by endoscopic carbon dioxide laser diverticulotomy at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic, were prospectively stored and followed in relatively short period from May 2009 to December 2013. The average length of diverticulum was 32 mm. The average duration of surgery was 32 min. The patients were fed via feeding tube for 6.1 days and antibiotics were administered for 7 days. Mean hospitalization time was 7.4 days. We observed one transient recurrent laryngeal nerve paralysis and no other serious complications. Recurrence rate was 3%. We recommend complete transection of the diverticular septum in one procedure, systemic antibiotic treatment and exclusion of transoral intake for minimally 5 days, and contrast oesophagogram before resumption of oral intake to exclude fistula. Open diverticulectomy should be reserved for cases with inadequate endoscopic exposure and for revision surgery for multiple recurrences from endoscopic diverticulotomies.

Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine Charles University University Hospital Motol 5 Úvalu 84 150 06 Prague 5 Czech Republic

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Kaplan S. Paralysis of deglutition, a post-poliomyelitis complication treated by section of the cricopharyngeus muscle. Annals of Surgery. 1951;133(4):572–573. PubMed PMC

van Overbeek JJM. Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Annals of Otology, Rhinology and Laryngology. 1994;103(3):178–185. PubMed

Martin-Hirsch DP, Newbegin CJR. Autosuture GIA gun: a new application in the treatment of hypopharyngeal diverticula. Journal of Laryngology and Otology. 1993;107(8):723–725. PubMed

Collard JM, Otte JB, Kestens PJ. Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Annals of Thoracic Surgery. 1993;56(3):573–576. PubMed

Prisman E, Genden EM. Zenker diverticulum. Otolaryngologic Clinics of North America. 2013;46(6):1101–1111. PubMed

Brombart M. Zenker’s pharyngo-esophageal diverticulum, pathogenic considerations on radiological studies on 26 cases (23 cases in initial stage) Journal Belge de Radiologie. 1953;36:166–197. PubMed

Chang CW, Burkey BB, Netterville JL, Courey MS, Garrett CG, Bayles SW. Carbon dioxide laser endoscopic diverticulotomy versus open diverticulectomy for Zenker’s diverticulum. Laryngoscope. 2004;114(3):519–527. PubMed

Rizzetto C, Zaninotto G, Costantini M, et al. Zenker’s diverticula: feasibility of a tailored approach based on diverticulum size. Journal of Gastrointestinal Surgery. 2008;12(12):2057–2065. PubMed

Bloom JD, Bleier BS, Mirza N, Chalian AA, Thaler ER. Factors predicting endoscopic exposure of Zenker’s diverticulum. Annals of Otology, Rhinology and Laryngology. 2010;119(11):736–741. PubMed

Helmstaedter V, Engel A, Huttenbrink K, Guntinas-Lichius O. Carbon dioxide laser endoscopic diverticulotomy for Zenker’s diverticulum: results and complications in a consecutive series of 40 patients. ORL. 2008;71(1):40–44. PubMed

Mantsopoulos K, Psychogios G, Karatzanis A, et al. Clinical relevance and prognostic value of radiographic findings in Zenker’s diverticulum. European Archives of Oto-Rhino-Laryngology. 2014;271(3):583–588. PubMed

Verhaegen VJO, Feuth T, van den Hoogen FJA, Marres HAM, Takes RP. Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple-assisted diverticulostomy to treat Zenker’s diverticulum. Head and Neck. 2011;33(2):154–159. PubMed

Koch M, Mantsopoulos K, Velegrakis S, Iro H, Zenk J. Endoscopic laser-assisted diverticulotomy versus open surgical approach in the treatment of Zenker’s diverticulum. Laryngoscope. 2011;121(10):2090–2094. PubMed

Adam SI, Paskhover B, Sasaki CT. Laser versus stapler: outcomes in endoscopic repair of Zenker diverticulum. Laryngoscope. 2012;122(9):1961–1966. PubMed

Peretti G, Piazza C, del Bon F, Cocco D, de BeneDetto L, Mangili S. Endoscopic treatment of Zenker’s diverticulum by carbon dioxide laser. Acta Otorhinolaryngologica Italica. 2010;30(1):1–4. PubMed PMC

Benjamin B, Gallagher R. Microendoscopic laser diverticulotomy for hypopharyngeal diverticulum. Annals of Otology, Rhinology and Laryngology. 1993;102(9):675–679. PubMed

Zbaren P, Schar P, Tschopp L, Becker M, Hausler R. Surgical treatment of Zenker’s diverticulum: transcutaneous diverticulectomy versus microendoscopic myotomy of the cricopharyngeal muscle with CO2 laser. Otolaryngology—Head and Neck Surgery. 1999;121(4):482–487. PubMed

Aly A, Devitt PG, Jamieson GG. Evolution of surgical treatment for pharyngeal pouch. The British Journal of Surgery. 2004;91(6):657–664. PubMed

C-reactive protein as an early marker of postoperative leakage in patients after endoscopic laser assisted Zenker's diverticulotomy