DIVERTICULE DE ZENKER PDF

Fera Principles of surgical treatment of Zenker diverticulum Access to the full text of this article requires a subscription. The change in direction of the muscular fibers, from circular at the esophagus, to oblique at the stomach, makes it difficult to develop the necessary submucosal plane for dividing the muscular fibers. The indication for surgical treatment was based on the severe dysphagia, which may cause in more than half of the patients, important weight loss. The trauma of the pharyngeal posterior wall occurs intraoperatively and can pass unnoticed. The hypo pharynx is exposed using bivalve Weerda laryngoscope, which is positioned behind the endo-tracheal tube, by using an upper digestive endoscope, so that the two blades enter one in the esophageal lumen and the other in the diverticular pouch, exposing the separating septum.

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Fera Principles of surgical treatment of Zenker diverticulum Access to the full text of this article requires a subscription. The change in direction of the muscular fibers, from circular at the esophagus, to oblique at the stomach, makes it difficult to develop the necessary submucosal plane for dividing the muscular fibers. The indication for surgical treatment was based on the severe dysphagia, which may cause in more than half of the patients, important weight loss.

The trauma of the pharyngeal posterior wall occurs intraoperatively and can pass unnoticed. The hypo pharynx is exposed using bivalve Weerda laryngoscope, which is positioned behind the endo-tracheal tube, by using an upper digestive endoscope, so that the two blades enter one in the esophageal lumen and the other in the diverticular pouch, exposing the separating septum.

The different incidence related to race or geographic area and the communicated familial cases may suggest the implication of a genetic mechanism. Upper Hematemesis Melena Lower Hematochezia. The simple approach of the diverticular pouch through diverticulectomy or diverticulopexy is insufficient, the therapeutic protocol imposes the interception of etiologic mechanisms, esophageal myotomy distal to the diverticular opening being indispensable. The advantages compared with classic surgery are the absence of scar, diminished postoperative pain, early reestablishing of oral feeding and reduced length of hospital stay [ 24 ].

The conservation of the diverticular pouch after diverticulopexy eznker for the first time described by Schmid inand made popular by Belsey and Skinner [ ]. Nowadays, therapeutic management of Zenker diverticulum implies 2 objectives, each one with specific technical details: Minimally siverticule surgery for Zenker diverticulum: We have routinely performed esophageal myotomy, distal to the diverticular opening, regardless of the manometry findings or the intraoperative aspect of the muscular layer.

Using the technique available at that time, the results were unacceptable, due to high incidence of mediastinal infectious complications. The treatment consists in a diverticulectomy combined with an esophageal myotomy, which aims to treat motor disorders and to prevent fistula at the level of the diverticulectomy area. The patient was proposed a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction.

Principles of surgical treatment of Zenker diverticulum You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.

B DallemagneZenier Perretta. Diverticule pharyngo- oesophagien de zenker a propos de cinq cas. The aim of the study is the reevaluation of the methods and therapeutic principles in pharyngo-esophageal diverticular disease, starting from the etio pathogeny. Ivor-Lewis esophagectomy with the patient in a left lateral position: Author information Article notes Copyright and License information Disclaimer. Law focuses on the different diagnostic and therapeutic options of endoscopy.

The etiology remains controversial, although most of the theories are linked to structural or functional abnormalities of the crico-pharyngeal muscle. The technical key steps of the surgical procedure are presented in a step diverticulle step way: Esophageal peptic stricture and shortened esophagus managed by a laparoscopic Collis-Nissen procedure.

The opponents of this technique rise attention about the risk of abandoning a possible malignant lesion inside the pouch, on one side and on the other side, that the resection is not much more complicated than diverticulopexy [ ].

Access to the text HTML. This video demonstrates a laparoscopic enucleation of a leiomyoma of the GE junction. The myotomy is zenked just above the gastroesophageal junction and extended 6 cm proximally and 2 cm distally onto the stomach using robotic articulated scissors.

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Tale Diverticula of the esophagus. Thoracoscopic esophageal diverticulectomy and myotomy. First attempts of endoscopic treatment of Zenker diverticulum, by cutting the muscular septum that separates the diverticular pouch from the esophageal lumen zen,er belongs to Mosher, in [ 26 ]. On the other hand, postoperative fistula at this level has a good prognosis under conservative treatment, being enough wide drainage by opening the cervical wound and NPO, with the healing of the leak in a couple of days. Especially in the two cases with esophageal leak, the follow-up time years was short and there were plenty of possibilities to obtain different results after the reevaluation of the patients. Pharyngo-esophageal diverticula are most frequently described in elderly patients, having symptoms such as dysphagia, regurgitation, chronic cough, aspiration and weight loss.

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Dupa mecanismul de producere se clasifica in: de tractiune, cind forta cauzatoare se exercita din afara peretelui esofagian de presiune, cind forta cauzatoare se aplica dinauntrul lumenului esofagian diverticuli micsti. Cauze: majoritatea diverticulilor sunt determinati de afectiuni ale motilitatii esofagiene leziunile structurale, incluzind un cricofaringian necompliant, relaxare incompleta sau necoordonata cu deglutitia a sfincterului esofagian inferior stricturi, procese inflamatorii mediastinale. Semne si simptome Simptomatologia clinica se instaleaza in cazurile de diverticuli mari sau complicatii. In diverticulul Zenker primul simptom este disfagia determinata de compresiunea pungii diverticulare pline cu alimente inghitite si retinute pe esofag. La aceasta se adauga regurgitatiile cu alimente stagnate, hipersalivatie si voce bitonala determinata de compresiunea pe nervul recurent. Alte semne si simptome intilnite cuprind: senzatia de alimente blocate in git tuse dupa masa aspirarea de alimente in trahee scadere ponderala inexplicabila foetor esofagian zgomote hidroaerice esofagiene. Simptomele pot dura de la luni pina la ani de zile.

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