Zenker diverticulectomy

The esophageal diverticulum is a blind pocket that covers the epithelium with the esophageal lumen. Congenital esophageal diverticulum is clinically rare. May be a variation of esophageal repetition. The true diverticulum should have a mucosa, submucosa, and esophageal muscle layer, starting with a small blind pocket, which later increases due to the mechanism of a similar bulging diverticulum. Congenital diverticulum can occur at any level of the esophagus. Common sites are the pharyngeal tube and the esophagus. Symptoms can occur in the later stages of the baby and early childhood, mainly as a result of slow dysphagia and repeated respiratory infections. The diverticulum located in the pharyngeal esophageal area has earlier symptoms, and symptoms similar to esophageal atresia occur in the neonatal period. Common symptoms include convulsions, reflux, and coughing during feeding. A small number of sick children can be accompanied by esophageal fistula. Esophageal barium meal angiography can confirm the diagnosis. The esophageal diverticulum is shown and should be photographed in a positive position. Endoscopy can confirm the pharyngeal esophageal diverticulum and can be associated with malformations, such as esophageal fistula. Be alert to the risk of perforation during microscopy. Surgical removal of the diverticulum is the best treatment. Treatment of diseases: esophageal diverticulum esophageal diverticulum Indication Zenker's diverticulum resection is suitable for diverticulum enlargement, with saliva and food reflux, cough and other symptoms. Preoperative preparation Clear flow 48 hours before surgery to avoid food retention. Wash the diverticulum with plenty of water. Oral 2% streptomycin solution, 4 times a day. The stomach tube was placed through the nasal cavity before surgery. Surgical procedure Incision The left neck sternocleidomastoid anterior oblique incision, from the level of the hyoid bone to the clavicle 1cm. 2. Exposing the chamber Cut the platysma and pull the sternocleidomastoid and carotid sheath back to the outside. The scapular scapula muscles are pulled forward and inward, exposing the esophagus, and finding the diverticulum. Separate to the neck of the diverticulum and make a marker suture in the section. 3. Excision The neck of the diverticulum is clamped at right angles with the longitudinal axis of the esophagus, and the nasogastric tube is pushed into the esophageal lumen before the upper forceps. It is not advisable to excessively pull the diverticulum before clamping, so as to avoid excessive removal of the esophageal mucosa and cause esophageal stricture. The wall of the capsule was cut at 2 mm distal to the opening of the diverticulum, and the slit was cut at the side, and the wall of the capsule was sutured intermittently with a thin thread, and the knot was struck in the esophageal lumen. When cutting the diverticulum, the surrounding area is protected with a gauze pad and attracted at any time to avoid contamination of the contents of the diverticulum. 4. Check the repair room The nasogastric tube was pulled to the esophageal repair level for inflation test, and the diverticulum suture was checked for air leakage. If gas escapes, fill the seam with a thin wire. The nasogastric tube is then inserted into the stomach for postoperative decompression. 5. Incision built-in drainage strip, sutured layer by layer. complication 1. The fistula is formed: saliva appears at the incision drainage. Often occurs about 1 week after surgery. If the mouth is not large, the drainage is sufficient, fasting, parenteral nutrition, mostly self-healing after weeks or months. 2. Recurrent laryngeal nerve injury: If it is caused by temporary injury caused by pulling, it can be recovered. 3. Esophageal stenosis: Excessive mucosal resection during diverticulum resection, dysphagia after operation, and dilatation is effective.