ONE MORE GOOD PLACE FOR TUNNEL! COMPARATIVE RESULTS OF ENDOSCOPIC OPERATIONS FOR ZENKER´S DIVERTICULUM ON 135 CASES

Aims The best option of treatment of Zenker´s diverticulum is still controversial. Recent data shows that same effectiveness of flexible endoscopy and traditional surgery. The only drawback of endoscopic technique is the limitation of myotomy level, which can result in the relapse of symptoms. Driven by new technologies we started to utilize the tunnel technique in patients with Zenker´s diverticulum.

Aim is to evaluate the effectiveness of endoscopic crycopharingoesophagomyotomy using a different techniques in the treatment of patients with Zenker´s diverticulum.

Methods In the period from July 2014 to November 2019, endoscopic surgery in MCSC A.S. Loginov for Zenker´s diverticulum was performed in 135 patients. The average age of patients was 66 (from 34 to 86 years). According to the traditional method, 35 patients were operated on (I group). The average operative time was 42 minutes. According to the tunnel technique, 37 patients were operated on (group II). The mean operative intervention time was 50 minutes. According to the combined method, 63 patients were operated on. The average operative time was 31 minutes.

Results The peculiarity of the patients who underwent surgery using the new combined method was the almost complete absence of the residual cavity of the diverticulum during the X-ray control examination.

Three patients in the group of traditional endoscopic treatment were re-operated because of complaints recurrence; No recurrence of symptoms was observed after tunnel or combined technique.

Conclusions Combined and tunneled endoscopic surgery for Zenker´s diverticulum allows to successfully expand the scope of surgical intervention by performing an extended myotomy and dissection of the mucous membrane of the septum. This allows you to create conditions for the prevention of recurrence of the disease, thereby providing the best result of treatment.