Cricopharyngeal myotomy and Zenker’s diverticulectomy

Cricopharyngeal myotomy and Zenker’s diverticulectomy

Cricopharyngeal myotomy and Zenker’s diverticulectomy are surgical procedures to relieve the obstruction caused by the muscle between the pharynx and the esophagus and to remove the outpouching of the inner layer of esophagus through this area. These procedures are performed to treat Zenker’s diverticulum.

Operation

The name of the procedure is “Open cricopharyngeal myotomy and Zenker’s diverticulectomy.” We perform this operation through an incision in the left neck. We carefully dissect down to the pharynx and esophagus, identify the diverticulum and the Killian’s triangle, divide the cricopharyngeal muscle and resect the diverticulum with a linear stapler. A small drain is left at the site of the surgery overnight.

Overall, the risks of the operation are very low. With any operation, there is a risk of injuring any structure that we operate around including the esophagus, recurrent laryngeal nerve and trachea. Other risks include bleeding and infection at the site of surgery.

Hospital Stay: 1 to 2 Days

After the operation, the patient goes to a recovery area called PACU or post-anesthesia care unit. Once the patient recovers from anesthesia, the patient is admitted under observation on the floor. On average, patients are in the hospital for one night. Patients are kept NPO or nothing by mouth overnight. The next day, patients undergo an esophagram to ensure that there are no issues with the operation. After the esophagram, patients start a liquid diet. During the hospital stay, patients have pre-emptive pain control with around the clock pain medication. If patients can tolerate a liquid diet with good pain control, they are ready to continue the recovery at home. The drain is removed prior to going home.

Diet

At home, we ask patients to have a liquid diet for two weeks to prevent any vomiting episodes that would cause complications with the surgical repair. After two weeks, patients are asked to start a soft diet avoiding breads and tough meat such as steaks. When taking in a solid diet, it is very important to chew well and let the food pass down into the stomach before taking the next bite. You should be able to be back on a regular diet about four weeks after surgery.

Pain Management

We also advise our patients to stay ahead of the pain with pre-emptive pain control. Instead of taking pain medication after having pain, we ask patients to take pain medication in regular intervals. The typical regimen for post-operative pain medication is:

3 days of Aleve (Naprosyn) 1 tabs two times a day

5 days of Tylenol (Acetaminophen) 1 g three times a day

After 5 days, take Tylenol as needed. If this regimen is not adequate to control pain, we ask patients to call our office.

Activity

In order to further help with recovery from surgery, we advise patients to walk at least three times a day, work on the incentive spirometer, and sit in a chair for at least 6 hours a day for about a week after the surgery. As long as the patient is not on narcotic pain medication, it is safe to drive.