Manometric follow-up after resection of Zenker's diverticulum]

Since 1977, 15 patients have undergone surgery for Zenker's diverticula at the University of Würzburg Department of Surgery. We were able to follow up 6 of them after an average of 4 years (5 months to 10.5 years). Preoperative manometric findings available on one patient revealed markedly impaired coordination between pharyngeal contraction and relaxation of the upper esophageal sphincter. After resection of the diverticulum and myotomy of the upper sphincter this was not observed in any of the patients. Myotomy also was followed by significant lowering of resting pressure in the upper esophageal sphincter to mean levels of 18 mm Hg (normally 90-100 mm Hg). By contrast, one patient who did not undergo intraoperative myotomy had only a moderate reduction of resting pressure (to 30-45 mm Hg) and a normal maximum contraction pressure of 100 mm Hg. This patient developed a relapse. Our manometric evidence underscores the importance of intraoperative myotomy as an adjunctive procedure in diverticulum resection. By helping reduce the resistance imposed by interference of impaired coordination with pharyngeal contraction, it also results in a lower rate of relapse.