New Approach to Throat Surgery

April 29, 1996

NAPLES, Fla. -- Surgeons at Duke University Medical Center have demonstrated for the first time that they can successfully treat a disabling condition in the throats of the elderly using endoscopic techniques.

The disorder, called Zenker's diverticulum, occurs when a "pouch" forms on the back wall of the throat. The opening to this pouch often traps food, whether eaten or regurgitated. While physicians do not know what causes the condition, the pouches tend to form at a point of muscle weakness where the pharynx meets the esophagus.

Those suffering from Zenker's experience difficulty in swallowing and regurgitation; severe cases can lead to malnourishment and aspiration of food into the lungs, which can be life-threatening, especially for those who are disabled or in nursing homes.

Physicians are faced with a quandary in treating the disorder since traditional surgical methods -- whether an open approach through the neck or down the throat -- are risky and often lead to infections or complications that can be more debilitating than the disorder itself.

"Using endoscopic instruments that general surgeons use in the abdomen, we have developed a safe and effective treatment for a medical disorder that can be quite disabling in the elderly," said surgeon Dr. Richard Scher, assistant professor of otolaryngology at Duke.

The results of the Duke surgical experience were presented today (Jan. 6) by Scher during the southern section meeting of the American Laryngological, Rhinological and Otological Society. Scher collaborated with Dr. William Richtsmeier, chief of otolaryngology at Duke.

The goal of the endoscopic surgery is to remove the pouch by splitting the common wall between the pouch and esophagus.

"As we cut through the wall, a special endoscopic instrument staples the edges of the mucosal lining together as it cuts," Scher explained. "While this instrument has been used in surgeries in the abdomen, this instrumentation has not been used before in head and neck surgeries such as this. The instruments fit through the laryngoscope, which we use all the time to look into the throat."

Traditional surgical approaches required patients to spend two to four days in the hospital after surgery and meant that patients could not eat solid foods for almost a week. The various surgical approaches also carry risks for infection or damage to nerves located in the neck that feed the vocal cords.

"By performing the procedure endoscopically, our patients go home after an average of two days, and all are taking food within one to two days without complications," Scher said. "We have performed this procedure on five patients since spring and none have experienced any complications."

While the condition is relatively rare, Scher believes that it is greatly under- or misdiagnosed, since patients are usually elderly and may have other medical problems, and many physicians are reluctant to perform a risky surgery.

"The symptoms can be very subtle, and the only way to tell definitively if a patient has Zenker's is the barium swallow," Scher said. "Since most surgical options entail risks, many physicians are reluctant to treat the condition aggressively and instead tend to monitor the

condition closely."However, now that there is a procedure available that can effectively treat the condition without apparent complications, Scher said that more elderly patients should be able to obtain relief in the future.

Duke University

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