Name of the Procedure:

Diverticulectomy of Hypopharynx or Esophagus, with or without Myotomy; Cervical Approach

Summary

A diverticulectomy of the hypopharynx or esophagus is a surgical procedure to remove an abnormal pouch (diverticulum) in the throat or upper esophagus. This can help alleviate symptoms like difficulty swallowing or regurgitation. The surgery is performed through an incision in the neck.

Purpose

Medical Condition: The procedure addresses diverticula, which are pouches that can collect food and cause difficulty swallowing, regurgitation, cough, and aspiration. Goals: The main goal is to remove the diverticulum and, if necessary, perform a myotomy to relieve any underlying muscular tension. This aims to improve swallowing and reduce symptoms.

Indications

• Difficulty swallowing (dysphagia)
• Regurgitation of undigested food
• Chronic cough or aspiration
• Unexplained weight loss due to swallowing difficulties
• Diagnosed esophageal diverticulum via imaging or endoscopy

Preparation

• Fasting: No food or drink for at least 8 hours before the procedure.
• Medication Adjustments: Patients may need to pause blood thinners or other medications.
• Diagnostics: Preoperative imaging like a barium swallow or endoscopy to assess the diverticulum’s size and location.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and comfortable.
2. Incision: A horizontal or vertical incision is made in the neck (cervical approach).
3. Diverticulectomy: The surgeon locates and carefully removes the diverticulum.
4. Myotomy (if necessary): The surgeon may cut some of the muscle layers of the esophagus to ease pressure.
5. Closure: The incision is closed with sutures or staples, and a drainage tube may be placed temporarily.

Duration

The procedure typically takes between 1 to 3 hours.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeons specialized in otolaryngology or gastroenterology
• Anesthesiologists
• Operating room nurses
• Surgical technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Injury to nearby structures such as nerves or blood vessels
• Fistula formation (abnormal connection between esophagus and trachea)
• Difficulty swallowing post-surgery
• Anesthesia-related risks

Benefits

• Improved swallowing function
• Reduction or elimination of regurgitation and aspiration
• Enhanced quality of life
• Symptoms relief typically realized within weeks

Recovery

• Immediate Care: Monitoring in a recovery room post-surgery for several hours.
• Hospital Stay: Most patients stay in the hospital for 1-2 days.
• Diet: Transition from liquid to soft foods, then to a regular diet over several weeks.
• Activity: Patients may need to limit physical activity for a few weeks.
• Follow-up: Regular follow-up appointments to monitor healing and address any complications.

Alternatives

• Dietary Modifications: Altering food consistency to reduce symptoms.
• Endoscopic Treatment: Non-surgical procedures to manage smaller diverticula.
• Observation: Monitoring symptoms in cases where they are mild and infrequent.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not feel any pain.
• After Procedure: Some throat pain and swelling which can be managed with pain relievers.
• Recovery Period: Gradual return to normal swallowing function and daily activities. Regular follow-ups ensure proper healing and symptom relief.